Kimberly Virgo Russo, DT

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

2818 S Tripp Ave
Chicago, IL 60623-4336

Phone

(773) 240-5377

Fax

(815) 377-2424

NPI assigned

Jun 13, 2010

Last updated

Jun 30, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Virgo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Bridging the Gap Rehab Services, Corp

  • Early Intervention Provider Agency
  • Oak Lawn, IL
  • NPI 1477913101

  Developmental Therapist

  NPD (past)

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

{
    "created_epoch": "1276387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1073834172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7208 W LUNT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311125",
            "telephone_number": "708-717-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2818 S TRIPP AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234336",
            "telephone_number": "773-240-5377",
            "fax_number": "815-377-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIRGO RUSSO",
        "first_name": "KIMBERLY",
        "credential": "DT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-13",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "VIRGO",
            "credential": "DT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Agnes Callao Virata-Delgado, RN
• Leo Viray
• Virendra S. Bisla, MD, LTD (Heart Care Centers)
• Margaret Joanne Virgin, DO
• Alyssa Nicole Virginio, PT, DPT
• Ayna Virk
• Rashmi Virmani, MD
• Sumeet Virmani, MBBS MS
• Mark H. Virshbo, L.C.S.W.
• Maureen Louise Virts, AUD

• Developmental Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; 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.