Provider Demographics
NPI:1033289087
Name:FASSE, NORMAN ANTHONY (MPT)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:ANTHONY
Last Name:FASSE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W OMAHA ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2447
Mailing Address - Country:US
Mailing Address - Phone:605-721-5950
Mailing Address - Fax:605-721-5940
Practice Address - Street 1:1301 W OMAHA ST
Practice Address - Street 2:SUITE 115
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2447
Practice Address - Country:US
Practice Address - Phone:605-721-5950
Practice Address - Fax:605-721-5940
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5833362Medicaid
SD41869Medicare ID - Type Unspecified