Healthcare Provider Details

I. General information

NPI: 1639697022
Provider Name (Legal Business Name): JACOB KYLE RASEY PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 MEDINA RD # FC
AKRON OH
44333-2483
US

IV. Provider business mailing address

3447 LEIBY OSBORNE RD
SOUTHINGTON OH
44470-9729
US

V. Phone/Fax

Practice location:
  • Phone: 330-219-2741
  • Fax:
Mailing address:
  • Phone: 330-219-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019274
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: