Provider Demographics
NPI:1710326376
Name:RAINEY, CHARLES E (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:RAINEY
Suffix:
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 1:2211 BANCROFT DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-6230
Mailing Address - Country:US
Mailing Address - Phone:417-766-4785
Mailing Address - Fax:
Practice Address - Street 1:1253 MAKALAPA RD
Practice Address - Street 2:BLDG 1514
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4479
Practice Address - Country:US
Practice Address - Phone:808-473-2444
Practice Address - Fax:619-437-5614
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090193172251S0007X, 2251X0800X, 225100000X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical