Provider Demographics
NPI:1639697022
Name:RASEY, JACOB KYLE (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:KYLE
Last Name:RASEY
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 LEIBY OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44470-9729
Mailing Address - Country:US
Mailing Address - Phone:330-219-2741
Mailing Address - Fax:
Practice Address - Street 1:4125 MEDINA RD # FC
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2483
Practice Address - Country:US
Practice Address - Phone:330-219-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X, 390200000X
OHPT019274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program