Healthcare Provider Details

I. General information

NPI: 1124803358
Provider Name (Legal Business Name): BEVERLY RASMUSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 S GEORGE NIGH EXPY
MCALESTER OK
74501-7143
US

IV. Provider business mailing address

2013 N A ST
MCALESTER OK
74501-3026
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-8440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1671
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: