Provider Demographics
NPI:1679803845
Name:JASPERSEN, RACHEL ALICIA (PT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ALICIA
Last Name:JASPERSEN
Suffix:
Gender:F
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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:OK
Mailing Address - Zip Code:74941-0542
Mailing Address - Country:US
Mailing Address - Phone:918-637-3243
Mailing Address - Fax:918-966-3319
Practice Address - Street 1:119 SOUTHWEST MAIN
Practice Address - Street 2:
Practice Address - City:KEOTA
Practice Address - State:OK
Practice Address - Zip Code:74941
Practice Address - Country:US
Practice Address - Phone:918-966-3322
Practice Address - Fax:918-966-3319
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist