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General NPI Number Information
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NPI Number | 1598810376
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Entity Type | Individual
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Provider Name | MONICA ANNE RAINE PTA
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 11960 WESTLINE INDUSTRIAL DR STE 201
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3209
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Country | US
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Telephone | 870-404-3944
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 HOLGATE DR
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City | MANCHESTER
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State | MO
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Zip | 63021-6868
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Country | US
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Telephone | 870-404-3944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1811
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2014012166
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License Number State | MO
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