Healthcare Provider Details

I. General information

NPI: 1427375914
Provider Name (Legal Business Name): DANA R RAYNARD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA R GLAZNER

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 WESTCHESTER AVE
HARRISONVILLE MO
64701-1784
US

IV. Provider business mailing address

17134 BEL RAY PL
BELTON MO
64012-5331
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-3344
  • Fax: 816-380-3044
Mailing address:
  • Phone: 816-226-4011
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2010033320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: