Provider Demographics
NPI:1750807228
Name:GINO, RANDI R (PT, DPT)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:R
Last Name:GINO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6177 RIVER CREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0728
Mailing Address - Country:US
Mailing Address - Phone:951-653-4480
Mailing Address - Fax:951-653-5051
Practice Address - Street 1:6177 RIVER CREST DR STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0728
Practice Address - Country:US
Practice Address - Phone:951-653-4480
Practice Address - Fax:951-653-5051
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist