Provider Demographics
NPI:1780789479
Name:RAW, DEANNA S (PT)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:S
Last Name:RAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 BAKER LN STE 2
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5488
Mailing Address - Country:US
Mailing Address - Phone:775-826-0557
Mailing Address - Fax:775-826-0576
Practice Address - Street 1:3773 BAKER LN STE 2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5488
Practice Address - Country:US
Practice Address - Phone:775-826-0557
Practice Address - Fax:775-826-0576
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101323Medicare ID - Type UnspecifiedP.T.