Provider Demographics
NPI:1427375914
Name:RAYNARD, DANA R (DPT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:RAYNARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:R
Other - Last Name:GLAZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17134 BEL RAY PL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5331
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:815 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1784
Practice Address - Country:US
Practice Address - Phone:816-380-3344
Practice Address - Fax:816-380-3044
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4370050OtherMEDICARE PTAN
44388053OtherBCBS KC
MOT07000008Medicare PIN
MO44388023OtherBCBS OF KC
K86B00019Medicare PIN
MO44388013OtherBCBS
MO44388033OtherBCBS OF KC