MEDICARE: RICHARD P. CARR PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196223400	OTHER		DOL
2	6798651	OTHER	CA	CIGNA
3	ZZZ02428Z	OTHER		BLUE SHIELD
4	7920285	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1003899154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD P. CARR PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	PO BOX 612260
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95161-2260
Country	:	US
Telephone Number	:	877-325-2776
Fax Number	:	408-945-4011

Provider Business Practice Location Address
First Line	:	1 BAYWOOD AVE
Second Line	:	STE 1
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1523
Country	:	US
Telephone Number	:	650-348-9400
Fax Number	:	650-348-9402

Authorized Official
Title or Position	:	VICE PRESIDENT OF REVENUE CYCLE
Name	:	MR. JONATHAN DOCKERY
Credential	:
Telephone Number	:	760-602-4105

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	02/05/2016

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Directions to “RICHARD P. CARR PHYSICAL THERAPY INC ” Practice Location

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