Provider Demographics
NPI:1902361470
Name:RAUSCH, MITCHELL GLENN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:GLENN
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3921 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1359
Mailing Address - Country:US
Mailing Address - Phone:214-450-4943
Mailing Address - Fax:
Practice Address - Street 1:11751 ALTA VISTA RD STE 301
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6443
Practice Address - Country:US
Practice Address - Phone:817-337-3400
Practice Address - Fax:817-337-3443
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13152752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic