Healthcare Provider Details

I. General information

NPI: 1083662407
Provider Name (Legal Business Name): BARBARA JEAN BOUTELLE/CARLSBAD PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E VALLEY PKWY STE 5
ESCONDIDO CA
92027-2550
US

IV. Provider business mailing address

3070 MADISON ST
CARLSBAD CA
92008-2310
US

V. Phone/Fax

Practice location:
  • Phone: 760-233-9655
  • Fax: 760-233-9648
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-294-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. BARBARA JEAN BOUTELLE
Title or Position: OWNER/SECRETARY
Credential: PT
Phone: 760-591-7750