Provider Demographics
NPI:1326234162
Name:GAINES, RITA R (RPT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:R
Last Name:GAINES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W OXMOOR RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6329
Mailing Address - Country:US
Mailing Address - Phone:205-313-2800
Mailing Address - Fax:205-313-2801
Practice Address - Street 1:100 W OXMOOR RD
Practice Address - Street 2:SUITE 180
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6329
Practice Address - Country:US
Practice Address - Phone:205-313-2800
Practice Address - Fax:205-313-2801
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-42381OtherBCBS
AL510-95400OtherBCBS