Active NPI
Stacey Ann Lustila-Siats, P.T.
- Physical Therapist
- Chaska, MN
National Provider Identifier
1285831628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6661
- Practice address
- 1661 Park Ridge Dr
Chaska, MN 55318-2841 - Phone
- (952) 403-2781
- Fax
- (952) 403-3979
- NPI assigned
- Jun 29, 2007
- Last updated
- Jul 8, 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 | 6661 | MN | Primary |
Addresses
Primary practice location
1661 Park Ridge Dr
Chaska, MN 55318-2841
Mailing address
14987 River Oak CT
Savage, MN 55378-5609
Phone (952) 226-2736
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 |
|---|---|---|---|
| 6661 | MN | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285831628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14987 RIVER OAK CT",
"city": "SAVAGE",
"state": "MN",
"postal_code": "553785609",
"telephone_number": "952-226-2736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1661 PARK RIDGE DR",
"city": "CHASKA",
"state": "MN",
"postal_code": "553182841",
"telephone_number": "952-403-2781",
"fax_number": "952-403-3979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUSTILA-SIATS",
"first_name": "STACEY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "6661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chaska, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.