Healthcare Provider Details

I. General information

NPI: 1417480575
Provider Name (Legal Business Name): RAINE PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 ALBANY AVE
BROOKLYN NY
11203-2103
US

IV. Provider business mailing address

753 ALBANY AVE
BROOKLYN NY
11203-2103
US

V. Phone/Fax

Practice location:
  • Phone: 917-626-0530
  • Fax:
Mailing address:
  • Phone: 917-626-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number029251
License Number StateNY

VIII. Authorized Official

Name: DR. LORAINE ANTOINE
Title or Position: OWNER
Credential: DPT
Phone: 917-626-0530