MEDICARE: MR. ANDREW L RATHJEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1360	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275562761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW L RATHJEN PT

Provider Business Mailing Address
First Line	:	3213 W NORTH FRONT ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4026
Country	:	US
Telephone Number	:	308-381-2424
Fax Number	:	308-381-3646

Provider Business Practice Location Address
First Line	:	3213 W NORTH FRONT ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4026
Country	:	US
Telephone Number	:	308-381-2424
Fax Number	:	308-381-3646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/02/2017

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