Healthcare Provider Details

I. General information

NPI: 1770638140
Provider Name (Legal Business Name): ELLEN M RASMUSSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY # 2
OAKDALE NY
11769-1434
US

IV. Provider business mailing address

110 JUNIPER ST
ISLIP NY
11751-1224
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax: 631-218-2650
Mailing address:
  • Phone: 631-218-1545
  • Fax: 631-218-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009032-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: