Provider Demographics
NPI:1699483446
Name:NEWCOMB, RAIHNA MAKLAY (PTA)
Entity type:Individual
Prefix:
First Name:RAIHNA
Middle Name:MAKLAY
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CR 545
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-3401
Mailing Address - Country:US
Mailing Address - Phone:352-254-1977
Mailing Address - Fax:
Practice Address - Street 1:1104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5045
Practice Address - Country:US
Practice Address - Phone:352-568-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32404225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant