Basic Information
| Provider Information | |||||||||
| NPI: | 1326020868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD P CARR PHYSICAL THERAPY INC | ||||||||
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| OtherOrganizationName: | SANTA CLARA SPORTS THERAPY | ||||||||
| 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: | 2488 DE LA CRUZ BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950502923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082477278 | ||||||||
| FaxNumber: | 4082479320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | LASSON | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4085700510 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1799574 | 01 | CA | CIGNA | OTHER | ZZZ02429Z | 01 | CA | BLUESHIELD | OTHER | 8154566 | 01 | CA | AETNA | OTHER |