Provider Demographics
NPI:1376218263
Name:RAUCK, LOGAN CHAZ (DPT)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:CHAZ
Last Name:RAUCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:502-882-9379
Mailing Address - Fax:502-805-0526
Practice Address - Street 1:5170 CHARLESTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8400
Practice Address - Country:US
Practice Address - Phone:812-590-8888
Practice Address - Fax:812-590-8890
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014264A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist