Provider Demographics
NPI:1962760934
Name:RASMUSSEN-STALLCUP, EMILY RENEE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RENEE
Last Name:RASMUSSEN-STALLCUP
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RENEE
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:3912 SW MASON RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-7346
Mailing Address - Country:US
Mailing Address - Phone:479-586-4517
Mailing Address - Fax:
Practice Address - Street 1:RUSS PHYSICAL THERAPY
Practice Address - Street 2:1002 WESTPARK DR. #6
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-250-4014
Practice Address - Fax:479-250-4015
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2556225200000X
OK2118225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant