MEDICARE: CARROLA 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		CA

General Provider Information

NPI Number	:	1831261411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLA PHYSICAL THERAPY,INC.

Provider Business Mailing Address
First Line	:	1740 MARCO POLO WAY
Second Line	:	SUITE #3
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4522
Country	:	US
Telephone Number	:	650-552-9355
Fax Number	:	650-652-1951

Provider Business Practice Location Address
First Line	:	1740 MARCO POLO WAY
Second Line	:	SUITE #3
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4522
Country	:	US
Telephone Number	:	650-552-9355
Fax Number	:	650-652-1951

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. TONY JARA
Credential	:
Telephone Number	:	650-552-9355

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/21/2022

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