Ellery T. Russian, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00009931 Issued in WA

Practice address

1959 NE Pacific St
Box 356490
Seattle, WA 98195-0001

Phone

(206) 598-4830

Fax

(206) 598-4897

NPI assigned

Dec 29, 2006

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Equilibrium Physical Therapy, LLCGroup PAC ID 0941250856, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Equilibrium Physical Therapy, LLC

  • Physical Therapist
  • New York, NY
  • NPI 1811961667
  Medicare reassignment Care Compare group NPD
• D E Delopoulos

  • Hand Occupational Therapist
  • Long Branch, NJ
  • NPI 1477958411

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188950400000",
    "number": "1114083300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24366",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981240366",
            "telephone_number": "206-598-0502",
            "fax_number": "206-598-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 NE PACIFIC ST",
            "address_2": "BOX 356490",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981950001",
            "telephone_number": "206-598-4830",
            "fax_number": "206-598-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSIAN",
        "first_name": "ELLERY",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00009931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "69744U",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rufus Leon Russell Jr.
• Samuel Guy Russell, MD
• Shannon Russell, DPT
• Sharon Russell, LPN
• Stacy Michaela Russell, MD
• Alexandra Russo
• Alfred John Russo, D.A.O.M., L.AC.
• Christopher Russo
• Monica Russo, LICSW, CDP
• Anne Marie Rust

• Physical Therapist in Seattle, WA
• Providers in Seattle, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; 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.