Provider Demographics
NPI:1821418724
Name:RAUSCH, DEREK JOHN (ATC)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JOHN
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2720
Mailing Address - Country:US
Mailing Address - Phone:563-382-4770
Mailing Address - Fax:563-382-4785
Practice Address - Street 1:516 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2720
Practice Address - Country:US
Practice Address - Phone:563-382-4770
Practice Address - Fax:563-382-4785
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA003122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer