1881401354 NPI number — KEELIN D RASCH DPT

Table of content: KEELIN D RASCH DPT (NPI 1881401354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881401354 NPI number — KEELIN D RASCH DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASCH
Provider First Name:
KEELIN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881401354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47731-3276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-473-0181
Provider Business Mailing Address Fax Number:
812-492-6498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
918 BAUMAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62946-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-841-1575
Provider Business Practice Location Address Fax Number:
618-518-5142
Provider Enumeration Date:
12/17/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070028836 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 070028836 . This is a "LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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