Provider Demographics
NPI:1629071790
Name:RAINIS, MICHAEL ANTHONY JR (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:RAINIS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-2427
Mailing Address - Country:US
Mailing Address - Phone:570-874-2125
Mailing Address - Fax:570-874-4019
Practice Address - Street 1:649 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2427
Practice Address - Country:US
Practice Address - Phone:570-874-2125
Practice Address - Fax:570-874-4019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-015055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50000092OtherCAPITAL BLUE CROSS
PARA1307249OtherPA BLUE SHIELD
PAP00031425OtherRAILROAD MEDICARE
PARA1307249OtherPA BLUE SHIELD
PAP59005Medicare UPIN