Provider Demographics
NPI:1396575544
Name:RAINGE, HENRIETTA (CMT)
Entity type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:
Last Name:RAINGE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:HENA
Other - Middle Name:
Other - Last Name:RAINGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:141 SARATOGA AVE APT 1117
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7359
Mailing Address - Country:US
Mailing Address - Phone:510-393-2968
Mailing Address - Fax:
Practice Address - Street 1:2033 SANTA CLARA AVE STE A
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2777
Practice Address - Country:US
Practice Address - Phone:510-865-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist