Provider Demographics
NPI:1023166386
Name:RASMUSSEN, BRENT M (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:M
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-1104
Mailing Address - Country:US
Mailing Address - Phone:435-283-5662
Mailing Address - Fax:435-283-5666
Practice Address - Street 1:112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1104
Practice Address - Country:US
Practice Address - Phone:435-283-5662
Practice Address - Fax:435-283-5666
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4931765-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic