Provider Demographics
NPI:1073828497
Name:RAINEY, MICHAEL WADE JR (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WADE
Last Name:RAINEY
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 NOLENSVILLE PIKE STE 105
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7395
Mailing Address - Country:US
Mailing Address - Phone:615-445-4120
Mailing Address - Fax:615-445-4129
Practice Address - Street 1:6005 NOLENSVILLE PIKE STE 105
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-7395
Practice Address - Country:US
Practice Address - Phone:615-445-4120
Practice Address - Fax:615-445-4129
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
TN8742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4278895OtherBCBS OF TN
TN446631Medicare PIN
TN4278895OtherBCBS OF TN