Kathryn Gail Rustebakke, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

768 Issued in ND

Practice address

701 Demers Ave
Grand Forks, ND 58201-4506

Phone

(701) 772-2200

Fax

(701) 772-2800

NPI assigned

Apr 25, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Life Skills and Transition Center

  • Intellectual Disabilities Intermediate Care Facility
  • Grafton, ND
  • NPI 1558427708
  Medicare reassignment
• Brian V Jongeward

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1407909120
  NPD (past)
• Life Skills and Transition Center

  • Community/Behavioral Health Agency
  • Grafton, ND
  • NPI 1023751971
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1750500054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 S CAROL ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836461839",
            "telephone_number": "208-288-1155",
            "fax_number": "208-288-0424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014506",
            "telephone_number": "701-772-2200",
            "fax_number": "701-772-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTEBAKKE",
        "first_name": "KATHRYN",
        "middle_name": "GAIL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "28850",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "64-08167",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55119",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "B17461052130",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann Russell, LAMFT
• Matthew David Russell, ABA
• Rachel N Russell, CRDH
• Sue Ann Russell, PH.D.
• Tiffany D Russell
• Heather Lea Rusten, DO
• Daniel Richard Rustvang, FNP-C
• Pamela A Rustvang, NP
• RX Consult
• Casey J Ryan, MD

• Physical Therapist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Physical Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.