Basic Information
Provider Information
NPI: 1063577849
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RASMUSSEN
FirstName: KRISTIN
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: PHYSICAL THERAPIST
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 WILLMAR AVE SW
Address2: ACMC
City: WILLMAR
State: MN
PostalCode: 56201
CountryCode: US
TelephoneNumber: 3202315000
FaxNumber: 3202315607
Practice Location
Address1: 101 WILLMAR AVE SW
Address2: AFFILIATED COMMUNITY MEDICAL CENTERS
City: WILLMAR
State: MN
PostalCode: 56201
CountryCode: US
TelephoneNumber: 3202315000
FaxNumber: 3202315607
Other Information
ProviderEnumerationDate: 12/22/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1042MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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