Healthcare Provider Details

I. General information

NPI: 1518999085
Provider Name (Legal Business Name): JOEY RAINES DIRECTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 BROAD ST STE 4
CLIFTON NJ
07013-4201
US

IV. Provider business mailing address

13874 BENTLY CIR
FORT MYERS FL
33912-1987
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-7774
  • Fax: 866-621-5272
Mailing address:
  • Phone: 973-744-7774
  • Fax: 866-621-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00636900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: