Provider Demographics
NPI:1518142835
Name:RASMUSSEN, SALLY L (LPTA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:L
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 GOVERNORS HILL DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1372
Mailing Address - Country:US
Mailing Address - Phone:866-791-5766
Mailing Address - Fax:513-683-1500
Practice Address - Street 1:3797 SUMMIT GLEN RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3661
Practice Address - Country:US
Practice Address - Phone:269-599-0327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.06772225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant