MEDICARE: CHARLES E RAINEY 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	2251S0007X	Sports Physical Therapist	2009019317	MO
2	2251X0800X	Orthopedic Physical Therapist	2009019317	MO
3	225100000X	Physical Therapist	2009019317	MO
4	2251E1300X	Clinical Electrophysiology Physical Therapist	2009019317	MO

General Provider Information

NPI Number	:	1710326376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E RAINEY PT

Provider Business Mailing Address
First Line	:	2211 BANCROFT DR
Second Line	:
City	:	KAILUA
State	:	HI
Zip	:	96734-6230
Country	:	US
Telephone Number	:	417-766-4785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 MAKALAPA RD
Second Line	:	BLDG 1514
City	:	JBPHH
State	:	HI
Zip	:	96860-4479
Country	:	US
Telephone Number	:	808-473-2444
Fax Number	:	619-437-5614

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	03/26/2015

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