Provider Demographics
NPI:1952464398
Name:RIALTO PHYSICAL THERAPY CENTER, INC
Entity Type:Organization
Organization Name:RIALTO PHYSICAL THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BLUM-JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:909-873-8369
Mailing Address - Street 1:224 N RIVERSIDE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5968
Mailing Address - Country:US
Mailing Address - Phone:909-873-8369
Mailing Address - Fax:909-873-4975
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty