Provider Demographics
NPI:1932129152
Name:RAYNE, STEPHEN BROOKE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BROOKE
Last Name:RAYNE
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 1:415 MCFARLAN ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-1270
Mailing Address - Fax:610-444-1341
Practice Address - Street 1:415 MCFARLAN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2454
Practice Address - Country:US
Practice Address - Phone:610-444-1270
Practice Address - Fax:610-444-1341
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-010609-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396713Medicare ID - Type Unspecified