MEDICARE: MARK S RASETA D.P.T.

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	225100000X	Physical Therapist	PT.013284	OH

General Provider Information

NPI Number	:	1144516790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S RASETA D.P.T.

Provider Business Mailing Address
First Line	:	2048 NORTH RIVER RD NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-2543
Country	:	US
Telephone Number	:	330-372-5550
Fax Number	:	330-372-5551

Provider Business Practice Location Address
First Line	:	2048 NORTH RIVER RD NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-2543
Country	:	US
Telephone Number	:	330-372-5550
Fax Number	:	330-372-5551

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	03/10/2016

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