Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 4931765-2401 | UT |
NPI | 1023166386 |
---|---|
Provider Name | Dr. Brent M. Rasmussen |
First Address | Ephraim, UT 84627-1104 |
Second Address | Ephraim, UT 84627-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |