MEDICARE: DR. BRENT M. RASMUSSEN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	4931765-2401	UT

General Provider Information

NPI Number	:	1023166386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT M. RASMUSSEN PT, DPT

Provider Business Mailing Address
First Line	:	112 N MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1104
Country	:	US
Telephone Number	:	435-283-5662
Fax Number	:	435-283-5666

Provider Business Practice Location Address
First Line	:	112 N MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1104
Country	:	US
Telephone Number	:	435-283-5662
Fax Number	:	435-283-5666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	10/05/2022

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