Provider Demographics
NPI:1154901239
Name:RASSMAN, GAIGE LOGAN
Entity type:Individual
Prefix:
First Name:GAIGE
Middle Name:LOGAN
Last Name:RASSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45377-8725
Mailing Address - Country:US
Mailing Address - Phone:419-296-6388
Mailing Address - Fax:
Practice Address - Street 1:102 VENETIAN WAY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OH
Practice Address - Zip Code:45377-8725
Practice Address - Country:US
Practice Address - Phone:419-296-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20678225100000X
390200000X
OHPT020819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program