Provider Demographics
NPI:1225216658
Name:RUST, TRISTA (RPT)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:RUST
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-0280
Mailing Address - Country:US
Mailing Address - Phone:701-448-2331
Mailing Address - Fax:701-448-2441
Practice Address - Street 1:1177 BORDER LN
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:ND
Practice Address - Zip Code:58577-0447
Practice Address - Country:US
Practice Address - Phone:701-462-3396
Practice Address - Fax:701-462-3396
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist