Provider Demographics
NPI:1508421181
Name:RASTBERGER, ALICIA JANE (BS, LPTA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JANE
Last Name:RASTBERGER
Suffix:
Gender:F
Credentials:BS, LPTA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JANE
Other - Last Name:WYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11422 SEYMOUR LN
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-4633
Mailing Address - Country:US
Mailing Address - Phone:804-982-0531
Mailing Address - Fax:
Practice Address - Street 1:60 BRIMLEY DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-5148
Practice Address - Country:US
Practice Address - Phone:540-737-4505
Practice Address - Fax:540-737-4552
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603362225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant