MEDICARE: MR. JEFFREY CHARLES RAU PT, MS, FAAOMPT

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	9316	CO
2	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist	1135044	TX
3	2251X0800X	Orthopedic Physical Therapist	1135044	TX

General Provider Information

NPI Number	:	1598834178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY CHARLES RAU PT, MS, FAAOMPT

Provider Business Mailing Address
First Line	:	1659 SOTOGRANDE BLVD
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-8119
Country	:	US
Telephone Number	:	817-301-2622
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4102
Country	:	US
Telephone Number	:	817-338-4220
Fax Number	:	970-870-8099

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	09/15/2008

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