Provider Demographics
NPI:1710987482
Name:RAU, CRAIG TYLER (MPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:TYLER
Last Name:RAU
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6300
Mailing Address - Country:US
Mailing Address - Phone:989-892-4557
Mailing Address - Fax:989-892-4686
Practice Address - Street 1:2618 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6300
Practice Address - Country:US
Practice Address - Phone:989-892-4557
Practice Address - Fax:989-892-4686
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-04-21
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
MI5501008385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN85020001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER