MEDICARE: MRS. KATHLEEN MANNIX RAINS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT25744	CA

General Provider Information

NPI Number	:	1689975112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MANNIX RAINS PT

Provider Business Mailing Address
First Line	:	24232 CASTILLA LN
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-4142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3187 RED HILL AVE STE 200
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3454
Country	:	US
Telephone Number	:	714-975-8011
Fax Number	:	714-975-8023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	10/21/2019

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