Provider Demographics
NPI:1780731786
Name:RUST, CHRISTINA MARIE (DPT, PA-C)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:RUST
Suffix:
Gender:F
Credentials:DPT, PA-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:RUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT, PA-C
Mailing Address - Street 1:14 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-6366
Mailing Address - Country:US
Mailing Address - Phone:208-290-2856
Mailing Address - Fax:208-290-2856
Practice Address - Street 1:302 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1258
Practice Address - Country:US
Practice Address - Phone:208-263-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007582225100000X
IDPT-1097225100000X
IDRPT-1097225100000X
ORPT63869225100000X
WAPA60896309363A00000X
ORPA190463363A00000X
IDPA-1994363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID610394500OtherUS DEPT. OF LABOR
ID000010140548OtherREGENCE
IDTD058OtherBLUE CROSS OF IDAHO
ID1780731786Medicaid
ID870721965OtherSTATE INSURANCE FUND
IDP00306612OtherRAILROAD MEDICARE
IDP00306612OtherRAILROAD MEDICARE