Individual
KATHRYN GAIL RUSTEBAKKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
701 DEMERS AVE, GRAND FORKS, ND 58201-4506
(701) 772-2200
(701) 772-2800
Mailing address
1560 S CAROL ST, MERIDIAN, ID 83646-1839
(208) 288-1155
(208) 288-0424
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
768
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28850
BLUE CROSS BLUE SHIELD
—
05
—
55119
—
ND
01
—
64-08167
MEDICA
—
01
—
B17461052130
PREFERRED ONE
—
Enumeration date
04/25/2007
Last updated
07/09/2013
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