Basic Information
| Provider Information | |||||||||
| NPI: | 1811995079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAWE | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 188010 | ||||||||
| Address2: | |||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410188010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135574270 | ||||||||
| FaxNumber: | 5135573214 | ||||||||
| Practice Location | |||||||||
| Address1: | 2845 CHANCELLOR DR | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594264200 | ||||||||
| FaxNumber: | 8594264206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 02/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 10653 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7100188390 | 05 | KY | MEDICAID | P00288204 | 01 | OH | MEDICARE RAILROAD | OTHER | 2506934 | 05 | OH | MEDICAID |