Provider Demographics
NPI:1790556058
Name:RAUH, MITCHELL JOHN (PT, PHD, MPH)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JOHN
Last Name:RAUH
Suffix:
Gender:M
Credentials:PT, PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 N MAGNOLIA AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1274
Mailing Address - Country:US
Mailing Address - Phone:619-975-2730
Mailing Address - Fax:
Practice Address - Street 1:1571 N MAGNOLIA AVE STE 212
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1274
Practice Address - Country:US
Practice Address - Phone:619-975-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257472251S0007X, 261QP2000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy