Healthcare Provider Details

I. General information

NPI: 1992016810
Provider Name (Legal Business Name): LAURA ELIZABETH RAUH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1215
US

IV. Provider business mailing address

1200 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1215
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2866
  • Fax: 405-271-3360
Mailing address:
  • Phone: 405-271-2866
  • Fax: 405-271-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4212
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: