Provider Demographics
NPI:1548533961
Name:RAU, BOBBIE JO ANN (LAC)
Entity type:Individual
Prefix:MS
First Name:BOBBIE JO
Middle Name:ANN
Last Name:RAU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:BOBBIE JO
Other - Middle Name:ANN
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:17 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1151
Mailing Address - Country:US
Mailing Address - Phone:267-218-0445
Mailing Address - Fax:
Practice Address - Street 1:17 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1151
Practice Address - Country:US
Practice Address - Phone:267-218-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000997171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist