Sean Michael Derussy, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA013768 Issued in OH

Practice address

1198 Smiley Ave Ste F
Cincinnati, OH 45240-1866

Phone

(513) 671-6362

NPI assigned

Jun 27, 2024

Last updated

Jun 27, 2024By the provider in NPPES

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rehabclinics SPT, Inc.

  dba NovaCare Rehabilitation

  • Physical Therapy Clinic/Center
  • Chalfont, PA
  • NPI 1952009482
  NPD (past)

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1033954441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 EASTWOOD DR APT 10311",
            "city": "BATAVIA",
            "state": "OH",
            "postal_code": "451034414",
            "telephone_number": "513-405-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1198 SMILEY AVE STE F",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452401866",
            "telephone_number": "513-671-6362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUSSY",
        "first_name": "SEAN",
        "middle_name": "MICHAEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OH",
            "license": "PTA013768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara L Dermon
• Mariah L Dern, LPC
• Andrea Derossett
• Jamesha Brenda Derrickson
• Derringer Food Services, Inc.
• Abhijit N Desai, MD
• Halley Desai
• Kalpan Kumar Desai, M.D.
• Rima Rasesh Desai, M.D.
• Sajnee Desai

• Physical Therapy Assistant in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Physical Therapy Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; 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.