Provider Demographics
NPI:1538733365
Name:RASMUSSEN, OWEN E (PT)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:E
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1725
Mailing Address - Country:US
Mailing Address - Phone:440-554-3470
Mailing Address - Fax:
Practice Address - Street 1:117 VINEYARD RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1725
Practice Address - Country:US
Practice Address - Phone:440-554-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist