Individual provider Active NPI

Lustan Orlando Letts Jr., PTA

  • Physical Therapy Assistant
  • Hemet, CA
National Provider Identifier
1275268203
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
5501 Issued in CA
Practice address
2390 E Florida Ave
Hemet, CA 92544-4707
Phone
(951) 765-1474
Fax
(951) 765-1476
NPI assigned
Jul 22, 2022
Last updated
Jul 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 5501 CA Primary

Addresses

Primary practice location

2390 E Florida Ave
Hemet, CA 92544-4707

Mailing address

16270 Heritage Grove Rd
Riverside, CA 92504-5221
Phone (951) 237-8304

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vnex Rehab, Inc. CurrentSince Jul 24, 2022 Accepting new patients
Vnex Physical Therapy Corporation CurrentSince Sep 8, 2024 Accepting new patients

Locations

2390 E Florida Ave
Hemet, CA 92544
Phone (951) 492-0900

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1275268203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16270 HERITAGE GROVE RD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925045221",
            "telephone_number": "951-237-8304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2390 E FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925444707",
            "telephone_number": "951-765-1474",
            "fax_number": "951-765-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LETTS",
        "first_name": "LUSTAN",
        "middle_name": "ORLANDO",
        "name_suffix": "Jr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-22",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "5501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.