Provider Demographics
NPI:1972317238
Name:JASIAK, RACHAEL ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:JASIAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ELIZABETH
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:910 S US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8802
Practice Address - Country:US
Practice Address - Phone:269-775-6030
Practice Address - Fax:877-892-6252
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist