Provider Demographics
NPI:1699402149
Name:BARNES, RICHARD RYAN (DPT, ATC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:RYAN
Last Name:BARNES
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 PURDUE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-5137
Mailing Address - Country:US
Mailing Address - Phone:440-318-5235
Mailing Address - Fax:
Practice Address - Street 1:2730 WILSHIRE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4724
Practice Address - Country:US
Practice Address - Phone:310-984-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10337225100000X
SC5111282255A2300X
CA302166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer