Provider Demographics
NPI:1952190845
Name:RAINES, KIYA
Entity type:Individual
Prefix:
First Name:KIYA
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W SUNSET DR APT 115
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1151
Mailing Address - Country:US
Mailing Address - Phone:708-949-1588
Mailing Address - Fax:
Practice Address - Street 1:25520 S PHEASANT LN UNIT MN
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-8805
Practice Address - Country:US
Practice Address - Phone:815-521-0111
Practice Address - Fax:815-521-0222
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028057225100000X
AK239811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist