MEDICARE: RAYNA CREACH

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	225200000X	Physical Therapy Assistant	14-00399	KS

General Provider Information

NPI Number	:	1487042362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYNA CREACH

Provider Business Mailing Address
First Line	:	1293 JACKSON RD
Second Line	:
City	:	POMONA
State	:	KS
Zip	:	66076-9144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1293 JACKSON RD
Second Line	:
City	:	POMONA
State	:	KS
Zip	:	66076-9144
Country	:	US
Telephone Number	:	316-200-4405
Fax Number	:

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

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	12/31/2014

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Directions to “ RAYNA CREACH ” Practice Location

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