Provider Demographics
NPI:1598834178
Name:RAU, JEFFREY CHARLES (PT, MS, FAAOMPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:RAU
Suffix:
Gender:M
Credentials:PT, MS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 SOTOGRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-8119
Mailing Address - Country:US
Mailing Address - Phone:817-301-2622
Mailing Address - Fax:
Practice Address - Street 1:1109 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4102
Practice Address - Country:US
Practice Address - Phone:817-338-4220
Practice Address - Fax:970-870-8099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9316174400000X
TX1135044225500000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174400000XOther Service ProvidersSpecialist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist