Active NPI
Christine M Gustafson, PT
- Physical Therapist
- Rockford, IL
National Provider Identifier
1194937516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070003815
- Practice address
- 3616 N Main St
Rockford, IL 61103-2159 - Phone
- (815) 877-5932
- NPI assigned
- May 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070003815 | IL | Primary |
Addresses
Primary practice location
3616 N Main St
Rockford, IL 61103-2159
Mailing address
10808 N Main St
Rockton, IL 61072-9456
Phone (815) 624-2816
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070003815 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217548800000",
"number": "1194937516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10808 N MAIN ST",
"city": "ROCKTON",
"state": "IL",
"postal_code": "610729456",
"telephone_number": "815-624-2816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3616 N MAIN ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611032159",
"telephone_number": "815-877-5932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "CHRISTINE",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-06",
"last_updated": "2008-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070003815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.