Healthcare Provider Details

I. General information

NPI: 1922574417
Provider Name (Legal Business Name): RAE HOLDINGS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16455 W BLUEMOUND RD STE 110
BROOKFIELD WI
53005-5921
US

IV. Provider business mailing address

4701 COLUMBUS ST STE 100
VIRGINIA BEACH VA
23462-6725
US

V. Phone/Fax

Practice location:
  • Phone: 414-877-0348
  • Fax:
Mailing address:
  • Phone: 414-736-1317
  • Fax: 757-965-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD SALINAS
Title or Position: CEO
Credential:
Phone: 414-736-1317