MEDICARE: MR. NORMAN ANTHONY FASSE M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1137	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033289087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NORMAN ANTHONY FASSE M.P.T.

Provider Business Mailing Address
First Line	:	1301 W OMAHA ST
Second Line	:	SUITE 115
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2447
Country	:	US
Telephone Number	:	605-721-5950
Fax Number	:	605-721-5940

Provider Business Practice Location Address
First Line	:	1301 W OMAHA ST
Second Line	:	SUITE 115
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2447
Country	:	US
Telephone Number	:	605-721-5950
Fax Number	:	605-721-5940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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