Russell Wade Stephan, MSM MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT20296 Issued in FL

Practice address

9371 Cypress Lake Dr
Suite 20
Fort Myers, FL 33919-4939

Phone

(239) 415-2595

Fax

(239) 415-2597

NPI assigned

Nov 16, 2006

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124191226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9371 CYPRESS LAKE DR",
            "address_2": "SUITE 20",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194939",
            "telephone_number": "239-415-2595",
            "fax_number": "239-415-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9371 CYPRESS LAKE DR",
            "address_2": "SUITE 20",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194939",
            "telephone_number": "239-415-2595",
            "fax_number": "239-415-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHAN",
        "first_name": "RUSSELL",
        "middle_name": "WADE",
        "name_prefix": "Mr.",
        "credential": "MSM MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT20296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Steinke, ARNP
• Carissa Stemen
• Michael Stens, D.O.
• Amy Stenz, OT
• Anne Victoria Stephan
• Stephen E Smith MD PA
• Stephen L Magruder
• Stephen L. Helgemo, Jr., M.D., P.a.
• Stacy Elizabeth Stephen, MD
• Alexa Stephens, RBT

• Physical Therapist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.