Provider Demographics
NPI:1043330855
Name:RAU, WES L (PT)
Entity Type:Individual
Prefix:
First Name:WES
Middle Name:L
Last Name:RAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NW GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1531
Mailing Address - Country:US
Mailing Address - Phone:541-923-0410
Mailing Address - Fax:541-923-7393
Practice Address - Street 1:450 NW GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1531
Practice Address - Country:US
Practice Address - Phone:541-923-0410
Practice Address - Fax:541-923-7393
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138030OtherMEDICARE ID