Provider Demographics
NPI:1821494329
Name:BLYN, RICHARD (MS, AT,C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BLYN
Suffix:
Gender:M
Credentials:MS, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CELESTIAL CIR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-5102
Mailing Address - Country:US
Mailing Address - Phone:508-579-3013
Mailing Address - Fax:
Practice Address - Street 1:16 EVERETT ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2061
Practice Address - Country:US
Practice Address - Phone:508-579-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer