Provider Demographics
NPI:1093836082
Name:RAJNIC, BERYL WADSWORTH (PT)
Entity Type:Individual
Prefix:
First Name:BERYL
Middle Name:WADSWORTH
Last Name:RAJNIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 PEREGRINE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1380 ELM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4642
Practice Address - Country:US
Practice Address - Phone:717-399-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist