Dustin Storck, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

70015924 Issued in IL

Practice address

1190 Fortune Blvd
Shiloh, IL 62269-7358

Phone

(314) 286-6988

NPI assigned

Jan 29, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1841477288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 36",
            "city": "FARINA",
            "state": "IL",
            "postal_code": "628389421",
            "telephone_number": "618-795-0667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 FORTUNE BLVD",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697358",
            "telephone_number": "314-286-6988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORCK",
        "first_name": "DUSTIN",
        "credential": "D.P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-29",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "70015924",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2007034391",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MO",
            "license": "2007034391",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Shiloh, IL
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• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.