Healthcare Provider Details

I. General information

NPI: 1386957421
Provider Name (Legal Business Name): JEFFREY RAINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S LOOP 256
PALESTINE TX
75801-6901
US

IV. Provider business mailing address

PO BOX 4550
PALESTINE TX
75802-4550
US

V. Phone/Fax

Practice location:
  • Phone: 903-661-7169
  • Fax:
Mailing address:
  • Phone: 903-731-4555
  • Fax: 903-731-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: