Provider Demographics
NPI:1871728584
Name:RAUCH, JEREMY PAUL (MPT, PT)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:PAUL
Last Name:RAUCH
Suffix:
Gender:M
Credentials:MPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1555 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3401
Mailing Address - Country:US
Mailing Address - Phone:708-712-6475
Mailing Address - Fax:
Practice Address - Street 1:425 JOLIET ST
Practice Address - Street 2:SUITE 320
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1765
Practice Address - Country:US
Practice Address - Phone:219-864-0290
Practice Address - Fax:219-864-0376
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017057225100000X
IN05010723A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist