Provider Demographics
NPI:1194173526
Name:RAKSNIS, KEVIN P (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:RAKSNIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 GOLD STAR HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355
Mailing Address - Country:US
Mailing Address - Phone:860-536-1001
Mailing Address - Fax:860-536-1005
Practice Address - Street 1:2440 GOLD STAR HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355
Practice Address - Country:US
Practice Address - Phone:860-536-1001
Practice Address - Fax:860-536-1005
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist