Provider Demographics
NPI:1386034585
Name:RASNER, JORDAN (PTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:RASNER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 CAHILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-3886
Mailing Address - Country:US
Mailing Address - Phone:715-330-5547
Mailing Address - Fax:715-330-5807
Practice Address - Street 1:2706 CAHILL RD STE E
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3886
Practice Address - Country:US
Practice Address - Phone:715-330-5547
Practice Address - Fax:715-330-5807
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2274-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant