Healthcare Provider Details

I. General information

NPI: 1790556058
Provider Name (Legal Business Name): MITCHELL JOHN RAUH PT, PHD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 N MAGNOLIA AVE STE 212
EL CAJON CA
92020-1274
US

IV. Provider business mailing address

1571 N MAGNOLIA AVE STE 212
EL CAJON CA
92020-1274
US

V. Phone/Fax

Practice location:
  • Phone: 619-975-2730
  • Fax:
Mailing address:
  • Phone: 619-975-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number25747
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number25747
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number25747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: