Provider Demographics
NPI:1982738860
Name:RASMUSSEN, LYLE R (P T)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:R
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-2480
Mailing Address - Country:US
Mailing Address - Phone:573-302-0666
Mailing Address - Fax:
Practice Address - Street 1:5497A HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3026
Practice Address - Country:US
Practice Address - Phone:573-302-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist