Provider Demographics
NPI:1952446296
Name:RAWIE, INEKE EVERARDA (LPT)
Entity Type:Individual
Prefix:MS
First Name:INEKE
Middle Name:EVERARDA
Last Name:RAWIE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5723
Mailing Address - Country:US
Mailing Address - Phone:410-360-8811
Mailing Address - Fax:
Practice Address - Street 1:631 WASHINGTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2214
Practice Address - Country:US
Practice Address - Phone:410-986-0088
Practice Address - Fax:410-986-0131
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD103N004GMedicare ID - Type Unspecified