Provider Demographics
NPI:1053050633
Name:RAU, WILL GREGORY (STUDENT)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:GREGORY
Last Name:RAU
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8092 S ROSEMARY CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3225
Mailing Address - Country:US
Mailing Address - Phone:720-387-0631
Mailing Address - Fax:
Practice Address - Street 1:8092 S ROSEMARY CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3225
Practice Address - Country:US
Practice Address - Phone:720-387-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer