Provider Demographics
NPI:1508080367
Name:RAINEY-YATES, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RAINEY-YATES
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 1:7409 NE HAZEL DELL AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8337
Mailing Address - Country:US
Mailing Address - Phone:360-597-4048
Mailing Address - Fax:360-597-4572
Practice Address - Street 1:7409 NE HAZEL DELL AVE STE 112
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8337
Practice Address - Country:US
Practice Address - Phone:360-597-4048
Practice Address - Fax:360-597-4572
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT601355822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics