Provider Demographics
NPI:1265689251
Name:RAINEY, KIMBERLY ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:RAINEY
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 1:645 E STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5915
Mailing Address - Country:US
Mailing Address - Phone:208-939-9594
Mailing Address - Fax:208-939-9828
Practice Address - Street 1:645 E STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5915
Practice Address - Country:US
Practice Address - Phone:208-939-9594
Practice Address - Fax:208-939-9828
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist