MEDICARE: BRIAN RAYNER 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	PT22459	CA

General Provider Information

NPI Number	:	1609074509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN RAYNER PT

Provider Business Mailing Address
First Line	:	229 MARINE AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1247
Country	:	US
Telephone Number	:	949-412-2850
Fax Number	:	949-675-3458

Provider Business Practice Location Address
First Line	:	229 MARINE AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1247
Country	:	US
Telephone Number	:	949-412-2850
Fax Number	:	949-675-3458

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	05/27/2014

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