Lori B Gustafson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA004592 Issued in GA

Practice address

3034 County Road 611
Valley Head, AL 35989-4623

Phone

(912) 996-3567

Fax

(855) 232-8604

NPI assigned

Mar 22, 2019

Last updated

May 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grace Pelvic Health LLC

  • Physical Therapist
  • Hillsboro, TN
  • NPI 1538017934
  NPD Authorized official
• Advance Rehabilitation

  • Orthopedic Physical Therapist
  • Topeka, KS
  • NPI 1447225305
  NPD (past)
• Tullahoma Pediatric Therapy, LLC

  • Physical Therapist
  • Tullahoma, TN
  • NPI 1063042166
  NPD (past)

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

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1861952194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3034 COUNTY ROAD 611",
            "city": "VALLEY HEAD",
            "state": "AL",
            "postal_code": "359894623",
            "telephone_number": "912-996-3567",
            "fax_number": "855-232-8604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3034 COUNTY ROAD 611",
            "city": "VALLEY HEAD",
            "state": "AL",
            "postal_code": "359894623",
            "telephone_number": "912-996-3567",
            "fax_number": "855-232-8604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6001 SW 6th Ave Ste 230",
            "address_purpose": "LOCATION",
            "city": "Topeka",
            "state": "KS",
            "postal_code": "666151004",
            "country_code": "US",
            "telephone_number": "785-232-9805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "LORI",
        "middle_name": "B",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-22",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "7501",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AL",
            "license": "PTA10177",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KS",
            "license": "14-03493",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anesthesia Management Group of North Alabama,LLC
• Chiara Focardi, NBCCH
• Alisha Hamidian, PMHNP-BC
• John Wayne Moore, CRNP
• North Dekalb Primary Care, LLC
• Valley Head Drugs LLC

• Physical Therapy Assistant in Valley Head, AL
• Providers in Valley Head, AL by specialty
• Physical Therapy Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; 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.