Provider Demographics
NPI:1083228746
Name:RAYNER, KIRSTEN BROOKE (PT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:BROOKE
Last Name:RAYNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-1000
Mailing Address - Country:US
Mailing Address - Phone:109-078-9229
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:340 COMMERCE AVE STE 15
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7168
Practice Address - Country:US
Practice Address - Phone:910-637-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist