Provider Demographics
NPI:1649985888
Name:WASHINGTON, RAYNAL JEREMY
Entity type:Individual
Prefix:
First Name:RAYNAL
Middle Name:JEREMY
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 SHALAKO DR APT 1806
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-9620
Mailing Address - Country:US
Mailing Address - Phone:817-291-7912
Mailing Address - Fax:
Practice Address - Street 1:2920 SHALAKO DR APT 1806
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-9620
Practice Address - Country:US
Practice Address - Phone:817-291-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant