Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 8742 | TN |
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1073828497 |
---|---|
Provider Name | Michael Wade Rainey JR. |
First Address | Nashville, TN 37211-7395 |
Second Address | Nashville, TN 37211-7395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 28/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4278895 | BCBS OF TN (01) | TN |