Healthcare Provider Details

I. General information

NPI: 1518142835
Provider Name (Legal Business Name): SALLY L. RASMUSSEN LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 01/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3797 SUMMIT GLEN RD
DAYTON OH
45449-3661
US

IV. Provider business mailing address

8650 GOVERNORS HILL DR SUITE 180
CINCINNATI OH
45249-1372
US

V. Phone/Fax

Practice location:
  • Phone: 269-599-0327
  • Fax:
Mailing address:
  • Phone: 866-791-5766
  • Fax: 513-683-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.06772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: