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	3134934	OTHER	CA	CIGNA
2	7409638	OTHER	CA	AETNA
3	ZZZ60370Z	OTHER	CA	BLUESHIELD
4	196223400	OTHER	CA	DOL

General Provider Information

NPI Number	:	1245213305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD P. CARR PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	1505 MERIDIAN AVE
Second Line	:	STE A
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5353
Country	:	US
Telephone Number	:	408-264-6643
Fax Number	:	408-264-6652

Provider Business Practice Location Address
First Line	:	1505 MERIDIAN AVE
Second Line	:	STE A
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5353
Country	:	US
Telephone Number	:	408-264-6643
Fax Number	:	408-264-6652

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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