Nicholas Joseph Russo

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT36549 Issued in FL

Practice address

1777 Coburg Rd Ste 3
Eugene, OR 97401-5477

Phone

(541) 505-8041

NPI assigned

Nov 23, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, TX2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ati Holdings of Arizona LLCGroup PAC ID 2466732862, 223 clinicians

Benchmark Physical Therapy of Oregon LLCGroup PAC ID 0143510602, 124 clinicians

Ideal Physical Therapy of Texas LLCGroup PAC ID 0547583809, 359 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

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

• Ati Holdings of Arizona, LLC

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1871570309
  Medicare reassignment Care Compare group NPD
• Ideal Physical Therapy of Texas LLC

  • Physical Therapist
  • Plano, TX
  • NPI 1538573746
  Medicare reassignment Care Compare group NPD
• Benchmark Physical Therapy of Oregon LLC

  • Physical Therapist
  • Grants Pass, OR
  • NPI 1801257191
  Care Compare group
• Ideal Physical Therapy of Texas LLC

  • Durable Medical Equipment & Medical Supplies
  • Murphy, TX
  • NPI 1902773161
  NPD
• Ideal Rehabilitation LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1831353614
  NPD (past)

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

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781827200000",
    "number": "1053915819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 COBURG RD STE 3",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974015477",
            "telephone_number": "541-505-8041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16811 N Litchfield Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "853747062",
            "country_code": "US",
            "telephone_number": "602-313-4045",
            "fax_number": "623-322-0664",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3800 Sun City Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Sun City Center",
            "state": "FL",
            "postal_code": "335736805",
            "country_code": "US",
            "telephone_number": "813-633-9888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "NICHOLAS",
        "middle_name": "JOSEPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-23",
        "last_updated": "2026-06-19",
        "certification_date": "2026-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT36549",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "66114",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Amelia Russell, M.ED.
• Jennifer Marie Russell
• Joseph Michael John Russell, PA
• Kelly Hanh Russell, PA-C
• Marie Christine Russell
• Sarah Russo, RN IBCLC
• Robert Glen Rust Jr., D.M.D.
• Lisa A Ruth, MAT, ATR-P
• Ruth'S Foundations Shop
• Barbara Rutherford

• Physical Therapist in Eugene, OR
• Providers in Eugene, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.