Provider Demographics
NPI:1003265141
Name:RAUB, TERI (PTA)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:RAUB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1547
Mailing Address - Country:US
Mailing Address - Phone:785-263-3689
Mailing Address - Fax:
Practice Address - Street 1:103 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-1547
Practice Address - Country:US
Practice Address - Phone:785-263-3646
Practice Address - Fax:785-263-3689
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant