Derek Scott Rustich, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

302855 Issued in CA

Practice address

13220 Evening Creek Dr S Ste 109
San Diego, CA 92128-4103

Phone

(619) 510-5000

Fax

(619) 303-4230

NPI assigned

Sep 9, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• San Diego Sports Physical Therapy, PC

  • Physical Therapist
  • San Diego, CA
  • NPI 1295608420
  NPD Authorized official

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

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1972224673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 PRIMROSE DR",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920205644",
            "telephone_number": "619-510-5000",
            "fax_number": "619-303-4230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13220 EVENING CREEK DR S STE 109",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921284103",
            "telephone_number": "619-510-5000",
            "fax_number": "619-303-4230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8380 Center Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "LA Mesa",
            "state": "CA",
            "postal_code": "919422952",
            "country_code": "US",
            "telephone_number": "619-510-5000",
            "fax_number": "619-303-4230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8290 Vickers St Ste C",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921112116",
            "country_code": "US",
            "telephone_number": "619-510-5000",
            "fax_number": "619-303-4230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSTICH",
        "first_name": "DEREK",
        "middle_name": "SCOTT",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-09",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "302855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Robert Russo, FNP
• Riley Rosemary Russo
• Ryan Russo
• Terri A. Russo, MD
• Ryan Anthony Rust, PA-C
• Stacy Rustico, M.D.
• Scott Rustulka, MS, QASP
• Isabella Rusy
• Emily Ruth, AMFT
• Joseph Ruth, RN

• Physical Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; 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.