Provider Demographics
NPI:1225255979
Name:RAUSA, JOSEPHINE TAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:TAN
Last Name:RAUSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11578 STREAMPOINT DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3474
Mailing Address - Country:US
Mailing Address - Phone:951-688-7419
Mailing Address - Fax:951-688-7419
Practice Address - Street 1:10917 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3044
Practice Address - Country:US
Practice Address - Phone:951-358-2689
Practice Address - Fax:951-358-2697
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist