Provider Demographics
NPI:1114689155
Name:RAINEY, JOHN (CPED)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RAINEY
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 DURALEIGH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8106
Mailing Address - Country:US
Mailing Address - Phone:984-200-7950
Mailing Address - Fax:984-200-8370
Practice Address - Street 1:3100 DURALEIGH RD STE 207
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:984-200-7950
Practice Address - Fax:984-200-8370
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225000000X
VACPED4184224L00000X
VACFO04357225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter