Provider Demographics
NPI:1154578011
Name:RAKESTRAW, MARY L (RPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:RAKESTRAW
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:WESTPHALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65085-0228
Mailing Address - Country:US
Mailing Address - Phone:615-896-6400
Mailing Address - Fax:
Practice Address - Street 1:HC 65 BOX 6
Practice Address - Street 2:
Practice Address - City:WESTPHALIA
Practice Address - State:MO
Practice Address - Zip Code:65085-9702
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist