Healthcare Provider Details

I. General information

NPI: 1710326376
Provider Name (Legal Business Name): CHARLES E RAINEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 MAKALAPA RD BLDG 1514
JBPHH HI
96860-4479
US

IV. Provider business mailing address

2211 BANCROFT DR
KAILUA HI
96734-6230
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-2444
  • Fax: 619-437-5614
Mailing address:
  • Phone: 417-766-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2009019317
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2009019317
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2009019317
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number2009019317
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: