Provider Demographics
NPI:1497587760
Name:RAINWATER, KAYLIE NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:KAYLIE
Middle Name:NICOLE
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7926 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-6764
Mailing Address - Country:US
Mailing Address - Phone:361-935-8247
Mailing Address - Fax:
Practice Address - Street 1:1011 MEDICAL PLAZA DR STE 150
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3255
Practice Address - Country:US
Practice Address - Phone:281-367-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1397866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist