Provider Demographics
NPI:1902241938
Name:RASMUSSEN, ALICIA RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:RAE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:RAE
Other - Last Name:ZADOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2323 E PORTER AVE
Mailing Address - Street 2:UNIT 50
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-2717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1603
Practice Address - Country:US
Practice Address - Phone:800-255-0405
Practice Address - Fax:515-270-5383
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist