Healthcare Provider Details

I. General information

NPI: 1598834178
Provider Name (Legal Business Name): JEFFREY CHARLES RAU PT, MS, FAAOMPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 8TH AVE
FORT WORTH TX
76104-4102
US

IV. Provider business mailing address

1659 SOTOGRANDE BLVD
HURST TX
76053-8119
US

V. Phone/Fax

Practice location:
  • Phone: 817-338-4220
  • Fax: 970-870-8099
Mailing address:
  • Phone: 817-301-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9316
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number1135044
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1135044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: