Provider Demographics
NPI:1750087094
Name:TAYLOR, RAINA ALYSSA (DPT)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:ALYSSA
Last Name:TAYLOR
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17650 140TH AVE SE STE B7
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-6814
Practice Address - Country:US
Practice Address - Phone:425-430-0700
Practice Address - Fax:425-430-0710
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64818225100000X
WACP022146T225100000X
AZLPT-32761225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist