Active NPI
Gail Lyn Russell, LPTA
- Physical Therapy Assistant
- Oblong, IL
National Provider Identifier
1124220082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- Practice address
- 5224 N. 200TH St
Oblong, IL 62449 - Phone
- (618) 592-6353
- Fax
- (618) 546-2635
- NPI assigned
- Jun 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | IL | Primary |
Addresses
Primary practice location
5224 N. 200TH St
Oblong, IL 62449
Mailing address
1000 N Allen St
Robinson, IL 62454-1167
Phone (618) 544-3131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160-004226 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124220082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 N ALLEN ST",
"city": "ROBINSON",
"state": "IL",
"postal_code": "624541167",
"telephone_number": "618-544-3131",
"fax_number": "618-546-2635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5224 N. 200TH ST",
"city": "OBLONG",
"state": "IL",
"postal_code": "62449",
"telephone_number": "618-592-6353",
"fax_number": "618-546-2635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "GAIL",
"middle_name": "LYN",
"name_prefix": "Mrs.",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oblong, IL
- Ridgeview Care Center
- Ridgeview Care Center LLC
- Ridgeview Health and Rehab Center LLC
- Ridgeview Health and Rehab Center LLC
- Ridgeview Health and Rehab Center LLC
- Suiter Chiropractic, PLLC
- Jamie Nichole Christine Suiter, DC
- Ashley Lynn Swingler, M.S. CCC-SLP
- Marcia Thorsen, LCPC
- Barbara Afman Wilson, LCPC
Sources for this page
- 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.