Healthcare Provider Details

I. General information

NPI: 1629071790
Provider Name (Legal Business Name): MICHAEL ANTHONY RAINIS JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 S GARFIELD AVE
FRACKVILLE PA
17931-2427
US

IV. Provider business mailing address

649 S GARFIELD AVE
FRACKVILLE PA
17931-2427
US

V. Phone/Fax

Practice location:
  • Phone: 570-874-2125
  • Fax: 570-874-4019
Mailing address:
  • Phone: 570-874-2125
  • Fax: 570-874-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-015055
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: