Basic Information
| Provider Information | |||||||||
| NPI: | 1245587971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANEK | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | PRESTON | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 803 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TYNDALL | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570662116 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5210 RIVER RD N | ||||||||
| Address2: | |||||||||
| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973034568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033933624 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2012 | ||||||||
| LastUpdateDate: | 08/13/2012 | ||||||||
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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 | 2251G0304X | 6604 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.