Healthcare Provider Details

I. General information

NPI: 1114900263
Provider Name (Legal Business Name): RICHARD P CARR PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 FOREST AVE #104
SAN JOSE CA
95128-4817
US

IV. Provider business mailing address

246 SOBRANTE WAY
SUNNYVALE CA
94086-4807
US

V. Phone/Fax

Practice location:
  • Phone: 408-279-8501
  • Fax: 408-279-8504
Mailing address:
  • Phone: 408-733-3670
  • Fax: 408-245-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANNE LASSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 408-570-0510