Basic Information
| Provider Information | |||||||||
| NPI: | 1114900263 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD P CARR PHYSICAL THERAPY INC | ||||||||
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| OtherOrganizationName: | REHAB OUTCOME MANAGEMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 SOBRANTE WAY | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940864807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087333670 | ||||||||
| FaxNumber: | 4082457968 | ||||||||
| Practice Location | |||||||||
| Address1: | 2039 FOREST AVE | ||||||||
| Address2: | #104 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951284817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082798501 | ||||||||
| FaxNumber: | 4082798504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | LASSON | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4085700510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2210753 | 01 | FIRST HEALTH | OTHER | ZZZ04942Z | 01 | CA | BLUESHIELD | OTHER |