Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT017997 | PA |
NPI | 1003064197 |
---|---|
Provider Name | Bobby Lee Rainey |
First Address | Erie, PA 16505-4536 |
Second Address | Erie, PA 16506-3050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 07/04/2015 |