Provider Demographics
NPI:1558461574
Name:RAUCH, MIGNONE (PT)
Entity Type:Individual
Prefix:
First Name:MIGNONE
Middle Name:
Last Name:RAUCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 EAST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-1646
Mailing Address - Country:US
Mailing Address - Phone:979-743-4109
Mailing Address - Fax:979-743-2185
Practice Address - Street 1:205 EAST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1646
Practice Address - Country:US
Practice Address - Phone:979-743-4109
Practice Address - Fax:979-743-2185
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G4138Medicare UPIN