Provider Demographics
NPI:1831741776
Name:RAINES, WILSON T (PT)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:T
Last Name:RAINES
Suffix:
Gender:M
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:PO BOX 32569
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2569
Mailing Address - Country:US
Mailing Address - Phone:865-694-7725
Mailing Address - Fax:865-560-8551
Practice Address - Street 1:9430 PARK WEST BLVD STE 230
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4204
Practice Address - Country:US
Practice Address - Phone:865-560-8550
Practice Address - Fax:865-560-8551
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist