Lauretta Marie Rustad, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

39367 Issued in CA

Practice address

12402 Industrial Blvd
Suite B-2
Victorville, CA 92395-5871

Phone

(760) 955-6061

Fax

(760) 955-6062

NPI assigned

Sep 6, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New Life Physical Therapy Services PCGroup PAC ID 7214207125, 94 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Life Physical Therapy Services, PC

  • Physical Therapist
  • Beverly Hills, CA
  • NPI 1285160788
  Medicare reassignment Care Compare group NPD
• Peak Potential Physical Therapy

  • Physical Therapy Clinic/Center
  • Rancho Santa Margarita, CA
  • NPI 1386528412
  NPD Authorized official
• New Life Healthcare, LLC

  • Physical Therapy Clinic/Center
  • Greenville, SC
  • NPI 1275598039
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1083963839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24630 WASHINGTON AVE",
            "address_2": "STE. 200",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925626131",
            "telephone_number": "951-696-9353",
            "fax_number": "951-973-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12402 INDUSTRIAL BLVD",
            "address_2": "SUITE B-2",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955871",
            "telephone_number": "760-955-6061",
            "fax_number": "760-955-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTAD",
        "first_name": "LAURETTA",
        "middle_name": "MARIE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-06",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sylvia Ruiz
• Marlane Rulloda
• Leeann B Russell
• Mark Russell, M.D.
• Marlon Saint Steve Russell, M.D.
• Ruth Hernandez M.D Medical Professional Corporation
• Giorgia Ruzzene
• S.M. Bhatt, DDS, Inc
• S.M. Bhatt, DDS, Inc
• Kaamilah Bernice Saafir

• Physical Therapist in Victorville, CA
• Providers in Victorville, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.