Provider Demographics
NPI:1033994025
Name:CERYAK, RAINA ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:ELIZABETH
Last Name:CERYAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 VALENTINO DR APT 7323
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2843
Mailing Address - Country:US
Mailing Address - Phone:203-565-8378
Mailing Address - Fax:
Practice Address - Street 1:8100 BOONE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2689
Practice Address - Country:US
Practice Address - Phone:703-717-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist