Provider Demographics
NPI:1699765081
Name:RAU, MARK M (PT, MPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:RAU
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-933-1996
Practice Address - Street 1:140 SHEN ELK PLZ
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1165
Practice Address - Country:US
Practice Address - Phone:540-298-4749
Practice Address - Fax:540-298-4570
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305202033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V612C40Medicare PIN