Individual
MS. PENNY IRENE RAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
18687 MAIN STREET, GROVELAND, CA 95370
(209) 962-4035
(209) 962-5399
Mailing address
PO BOX 737, GROVELAND, CA 95321-0737
(209) 962-4035
(209) 962-5399
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PT 1291
CA
Other
Enumeration date
01/18/2008
Last updated
01/18/2008
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