Provider Demographics
NPI:1902108715
Name:GILES D. RAINWATER PHD, PA
Entity Type:Organization
Organization Name:GILES D. RAINWATER PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILES
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:RAINWATER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-729-0080
Mailing Address - Street 1:2210 FRONT ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7506
Mailing Address - Country:US
Mailing Address - Phone:321-729-0080
Mailing Address - Fax:321-574-3816
Practice Address - Street 1:2210 FRONT ST STE 208
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7506
Practice Address - Country:US
Practice Address - Phone:321-729-0080
Practice Address - Fax:321-574-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty