Provider Demographics
NPI:1801297908
Name:LARIOSA, RAINELDA (PT)
Entity type:Individual
Prefix:
First Name:RAINELDA
Middle Name:
Last Name:LARIOSA
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 1:126 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-3349
Mailing Address - Country:US
Mailing Address - Phone:731-599-9896
Mailing Address - Fax:866-611-9554
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-3349
Practice Address - Country:US
Practice Address - Phone:731-599-9896
Practice Address - Fax:866-611-9554
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000004747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPT0000004747OtherPHYSICAL THERAPIST LICENSE TENN HEALTH RELATED BOARDS