Provider Demographics
NPI:1982947644
Name:RAINES, MEGAN RENEE (ATC, LPTA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RENEE
Last Name:RAINES
Suffix:
Gender:F
Credentials:ATC, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CR 1560
Mailing Address - Street 2:
Mailing Address - City:RUSH SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:73082
Mailing Address - Country:US
Mailing Address - Phone:580-641-0030
Mailing Address - Fax:
Practice Address - Street 1:801 CR 1560
Practice Address - Street 2:
Practice Address - City:RUSH SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:73082
Practice Address - Country:US
Practice Address - Phone:580-641-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2005225200000X, 225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer