Provider Demographics
NPI:1043629033
Name:RAINES, ALLYSON
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2540 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9410
Mailing Address - Country:US
Mailing Address - Phone:716-862-0567
Mailing Address - Fax:716-862-0571
Practice Address - Street 1:2540 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9410
Practice Address - Country:US
Practice Address - Phone:716-862-0567
Practice Address - Fax:716-862-0571
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist