MEDICARE: VICTORIA L RAINVILLE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	006675	CT
2	225100000X	Physical Therapist	PT009716	GA

General Provider Information

NPI Number	:	1184778235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA L RAINVILLE PT

Provider Business Mailing Address
First Line	:	930 WOODSTOCK RD
Second Line	:	SUITE 310
City	:	ROSWELL
State	:	GA
Zip	:	30075-2220
Country	:	US
Telephone Number	:	770-998-6636
Fax Number	:	770-998-6646

Provider Business Practice Location Address
First Line	:	930 WOODSTOCK RD
Second Line	:	SUITE 310
City	:	ROSWELL
State	:	GA
Zip	:	30075-2220
Country	:	US
Telephone Number	:	770-998-6636
Fax Number	:	770-998-6646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/25/2020

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Directions to “ VICTORIA L RAINVILLE PT” Practice Location

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