Provider Demographics
NPI:1053525964
Name:RAUBE, ROSE MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIE
Last Name:RAUBE
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 1:375 BUSTLE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ALTA
Mailing Address - State:WY
Mailing Address - Zip Code:83414-4505
Mailing Address - Country:US
Mailing Address - Phone:307-353-2929
Mailing Address - Fax:
Practice Address - Street 1:120 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5112
Practice Address - Country:US
Practice Address - Phone:208-354-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA390174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist