Provider Demographics
NPI:1942597398
Name:RAU, MONICA JOANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JOANN
Last Name:RAU
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4733
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLBY
Mailing Address - State:WA
Mailing Address - Zip Code:98384-0733
Mailing Address - Country:US
Mailing Address - Phone:360-769-5944
Mailing Address - Fax:360-769-6250
Practice Address - Street 1:4459 SE MILE HILL DRIVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3908
Practice Address - Country:US
Practice Address - Phone:360-769-5944
Practice Address - Fax:360-769-6250
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160033896225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant