Provider Demographics
NPI:1285899468
Name:RASMUSSEN, TARA JEANNE (PT)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:JEANNE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1860 EL CAMINO REAL STE 201
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010
Mailing Address - Country:US
Mailing Address - Phone:650-259-8009
Mailing Address - Fax:650-259-9769
Practice Address - Street 1:619 E BLITHEDALE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1468
Practice Address - Country:US
Practice Address - Phone:415-388-5223
Practice Address - Fax:415-388-5270
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA29445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06873ZMedicare PIN
CACA190430Medicare PIN