Healthcare Provider Details

I. General information

NPI: 1699723098
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: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 MIRA MESA BLVD STE. 120
SAN DIEGO CA
92131-1056
US

IV. Provider business mailing address

3070 MADISON ST
CARLSBAD CA
92008-2310
US

V. Phone/Fax

Practice location:
  • Phone: 858-693-0436
  • Fax: 858-693-0437
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-294-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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