Healthcare Provider Details

I. General information

NPI: 1457276768
Provider Name (Legal Business Name): NICHOLAS M RASMUSSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19820 VILLAGE OFFICE CT STE 202
BEND OR
97702-2947
US

IV. Provider business mailing address

2615 NW SCANDIA LOOP
BEND OR
97703-8642
US

V. Phone/Fax

Practice location:
  • Phone: 541-480-4079
  • Fax:
Mailing address:
  • Phone: 541-410-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29722
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: