Active NPI
Rafael Carlos, DPT
- Physical Therapist
- Lodi, CA
National Provider Identifier
1093400707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 305524
- Practice address
- 2000 W Kettleman LN Ste 106
Lodi, CA 95242-4334 - Phone
- (209) 207-0849
- NPI assigned
- Apr 7, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 044165 | NY | |
| Physical Therapist | 225100000X | 305524 | CA | Primary |
Addresses
Primary practice location
2000 W Kettleman LN Ste 106
Lodi, CA 95242-4334
Mailing address
1742 S Breezy Meadow Dr
Sacramento, CA 95834-2683
Phone (628) 235-9743
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240315002225 | CA | Practitioner - Physical Therapist in Private Practice | 5395181028 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305524 | CA | MD | Physical Therapist |
| 044165 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706745600000",
"number": "1093400707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1742 S BREEZY MEADOW DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958342683",
"telephone_number": "628-235-9743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 W KETTLEMAN LN STE 106",
"city": "LODI",
"state": "CA",
"postal_code": "952424334",
"telephone_number": "209-207-0849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLOS",
"first_name": "RAFAEL",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-07",
"last_updated": "2024-02-01",
"certification_date": "2024-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "044165",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "305524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.