Provider Demographics
NPI:1285862078
Name:RASMUSSEN, RIC (PTA LMT)
Entity Type:Individual
Prefix:
First Name:RIC
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PTA LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NEBRASKA AVE
Mailing Address - Street 2:PO BOX 322
Mailing Address - City:ESSEX
Mailing Address - State:IA
Mailing Address - Zip Code:51638-8025
Mailing Address - Country:US
Mailing Address - Phone:712-621-4554
Mailing Address - Fax:
Practice Address - Street 1:401 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:IA
Practice Address - Zip Code:51638-8025
Practice Address - Country:US
Practice Address - Phone:712-621-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00519225200000X
IA03303225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist