Provider Demographics
NPI:1235829482
Name:RASMUS, NOAH GREY (LMT)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:GREY
Last Name:RASMUS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RHIANNON MARIE
Other - Last Name:RASMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5411 MOCKINGBIRD DR APT 20
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1688
Mailing Address - Country:US
Mailing Address - Phone:907-917-0759
Mailing Address - Fax:
Practice Address - Street 1:4045 LAKE OTIS PKWY STE 204
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5227
Practice Address - Country:US
Practice Address - Phone:907-276-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK202830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist