Provider Demographics
NPI:1598086308
Name:MITCHELL, RAINA NICOLE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:RAINA
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15342 SE 307TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5526
Mailing Address - Country:US
Mailing Address - Phone:253-394-8012
Mailing Address - Fax:
Practice Address - Street 1:15342 SE 307TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5526
Practice Address - Country:US
Practice Address - Phone:253-394-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60160171172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist