Basic Information
| Provider Information | |||||||||
| NPI: | 1174042295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAINIER | ||||||||
| FirstName: | HAYES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027662436 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024582063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172441990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2017 | ||||||||
| LastUpdateDate: | 09/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 23107 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 23107 | 01 | MA | LICENSE | OTHER |