=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194215400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANIER PHYSICAL THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2018
-----------------------------------------------------
Last Update Date | 05/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3755 OLD KY 17
-----------------------------------------------------
City | FORT WRIGHT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-916-1334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 DIVISION ST
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41073-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-916-1334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. RAYMOND GARDINIER
-----------------------------------------------------
Credential | PT, DPT, CSCS
-----------------------------------------------------
Telephone | 859-916-1334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 007342
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------