Active NPI
Rustico Mallillin
- Physical Therapist
- Bridgeton, MO
National Provider Identifier
1487758769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 3446 McKelvey Rd
Bridgeton, MO 63044-2525 - Phone
- (314) 298-0353
- NPI assigned
- Sep 8, 2006
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
3446 McKelvey Rd
Bridgeton, MO 63044-2525
Mailing address
25 Gloria LN
Saint Peters, MO 63376-2157
Phone (314) 550-9996
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2002006272 | Other | MO | LICENSE # |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487758769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 GLORIA LN",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633762157",
"telephone_number": "314-550-9996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3446 MCKELVEY RD",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442525",
"telephone_number": "314-298-0353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLILLIN",
"first_name": "RUSTICO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "2002006272",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
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.