Provider Demographics
NPI:1225240898
Name:RASMUSSEN, JANELLE MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:MARIE
Last Name:RASMUSSEN
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 1:264 LAZY D LN
Mailing Address - Street 2:
Mailing Address - City:GERALD
Mailing Address - State:MO
Mailing Address - Zip Code:63037-1556
Mailing Address - Country:US
Mailing Address - Phone:573-764-4268
Mailing Address - Fax:
Practice Address - Street 1:735 W SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:GERALD
Practice Address - State:MO
Practice Address - Zip Code:63037-2135
Practice Address - Country:US
Practice Address - Phone:573-764-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024776225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant