Provider Demographics
NPI:1003305079
Name:RAINIE, KELSEY (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:
Last Name:RAINIE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AVON ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2301
Mailing Address - Country:US
Mailing Address - Phone:603-848-1859
Mailing Address - Fax:
Practice Address - Street 1:10 AVON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2301
Practice Address - Country:US
Practice Address - Phone:603-848-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1256207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine