MEDICARE: BARBARA JEAN BOUTELLE/CARLSBAD PHYSICAL THERAPY

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	225XH1200X	Hand Occupational Therapist		CA
2	225100000X	Physical Therapist		CA

General Provider Information

NPI Number	:	1033167366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARBARA JEAN BOUTELLE/CARLSBAD PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3070 MADISON ST
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-2310
Country	:	US
Telephone Number	:	760-591-7750
Fax Number	:	760-294-9813

Provider Business Practice Location Address
First Line	:	850 MAIN ST
Second Line	:	STE. 105
City	:	RAMONA
State	:	CA
Zip	:	92065-1968
Country	:	US
Telephone Number	:	760-789-1424
Fax Number	:	760-789-1463

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/03/2022

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