Individual
DEREK RAYNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, PES, CFCE
Contact information
Practice address
5510 MACCORKLE AVE SE, CHARLESTON, WV 25304-2320
(304) 720-5433
Mailing address
5510 MACCORKLE AVE SE, CHARLESTON, WV 25304-2320
(304) 720-5433
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001306
WV
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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