Provider Demographics
NPI:1285794123
Name:RASURE, KRISTIN (MHS, PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:RASURE
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NORTH NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6825
Mailing Address - Country:US
Mailing Address - Phone:314-997-8700
Mailing Address - Fax:314-997-8799
Practice Address - Street 1:555 NORTH NEW BALLAS ROAD
Practice Address - Street 2:SUITE 225
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-997-8700
Practice Address - Fax:314-997-8799
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104477225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
222731806Medicare PIN