Provider Demographics
NPI:1518999085
Name:RAINES, JOEY (DIRECTOR)
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:
Last Name:RAINES
Suffix:
Gender:M
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13874 BENTLY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1987
Mailing Address - Country:US
Mailing Address - Phone:973-744-7774
Mailing Address - Fax:866-621-5272
Practice Address - Street 1:1425 BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4201
Practice Address - Country:US
Practice Address - Phone:973-744-7774
Practice Address - Fax:866-621-5272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00636900225700000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist