Provider Demographics
NPI:1922101336
Name:BLUM-JOHNSTON, RICHARD PAUL (MPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PAUL
Last Name:BLUM-JOHNSTON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:951-666-5096
Practice Address - Street 1:224 N RIVERSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5968
Practice Address - Country:US
Practice Address - Phone:909-873-8369
Practice Address - Fax:909-873-4975
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT229771Medicare PIN