Timothy A Russell

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT27587 Issued in FL

Practice address

11482 Okeechobee Blvd
Suite 2
Royal Palm Beach, FL 33411-8735

Phone

(561) 432-0111

Fax

(561) 432-1075

NPI assigned

Aug 15, 2012

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)

Enrolled

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590364800000",
    "number": "1013264530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6169 S JOG RD",
            "address_2": "SUITE A11",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334676579",
            "telephone_number": "561-432-0111",
            "fax_number": "561-432-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11482 OKEECHOBEE BLVD",
            "address_2": "SUITE 2",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "334118735",
            "telephone_number": "561-432-0111",
            "fax_number": "561-432-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-15",
        "last_updated": "2020-05-25",
        "certification_date": "2020-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT27587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Royal Palm Beach, FL
• Providers in Royal Palm Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2020; 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.