Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | NC |
NPI | 1114689155 |
---|---|
Provider Name | John Rainey |
First Address | Raleigh, NC 27612-8106 |
Second Address | Raleigh, NC 27612-8106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2021 |
Last Update Date | 28/10/2021 |