Healthcare Provider Details

I. General information

NPI: 1932797297
Provider Name (Legal Business Name): BLUE STONE THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 100TH ST STE 100
URBANDALE IA
50322-3874
US

IV. Provider business mailing address

2830 100TH ST STE 100
URBANDALE IA
50322-3874
US

V. Phone/Fax

Practice location:
  • Phone: 515-225-4070
  • Fax:
Mailing address:
  • Phone: 515-225-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS JOHNSON
Title or Position: FOUNDER AND CEO
Credential:
Phone: 515-225-4070