Active NPI
Frank Warren Gustafson, RPT
- Physical Therapist
- Indian Wells, CA
National Provider Identifier
1689746125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT14299
- Practice address
- 45240 Club Drive
Indian Wells, CA 92210 - Phone
- (760) 200-3322
- Fax
- (760) 200-3323
- NPI assigned
- Nov 13, 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 | PT14299 | CA | Primary |
Addresses
Primary practice location
45240 Club Drive
Indian Wells, CA 92210
Mailing address
45240 Club Drive
Indian Wells, CA 92210
Phone (760) 200-3322
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPT142990 | Other | BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14299 | CA | MD | General Practice Dentistry |
| PT14299 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689746125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45240 CLUB DRIVE",
"city": "INDIAN WELLS",
"state": "CA",
"postal_code": "92210",
"telephone_number": "760-200-3322",
"fax_number": "760-200-3323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45240 CLUB DRIVE",
"city": "INDIAN WELLS",
"state": "CA",
"postal_code": "92210",
"telephone_number": "760-200-3322",
"fax_number": "760-200-3323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "FRANK",
"middle_name": "WARREN",
"name_prefix": "Mr.",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT14299",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "OPT142990",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Indian Wells, CA
- Gary R. Smith DC a Professional Chiropractic Corporation
- Jullissa Marie Garza
- Kara Geno, APN
- Marianne Gregorich, FNP
- Michael Joseph Groban, M.D.
- Halo Medical Group (Desert Medical Imaging)
- Mohammad Hishmeh, DDS
- HMG Urology PC
- Indian Wells Medical Center
- Indian Wells Psychiatry & Counseling Center Inc.
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.