Healthcare Provider Details

I. General information

NPI: 1316648470
Provider Name (Legal Business Name): WILLIAM DESHAUN RASMUSSEN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 S PROGRESS WAY UNIT 104
PARKER CO
80134-4037
US

IV. Provider business mailing address

5985 S MEADOW LARK PL
CASTLE ROCK CO
80109-2841
US

V. Phone/Fax

Practice location:
  • Phone: 303-617-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0015325
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: