Individual provider Active NPI

Heather Renae Russon, PT, DPT

  • Physical Therapist
  • Cedar Park, TX
National Provider Identifier
1124630769
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1334406 Issued in TX
Practice address
2519 S Lakeline Blvd Ste 100
Cedar Park, TX 78613-2964
Phone
(512) 331-6200
Fax
(512) 331-6384
NPI assigned
Aug 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1334406 TX Primary

Addresses

Primary practice location

2519 S Lakeline Blvd Ste 100
Cedar Park, TX 78613-2964

Mailing address

2001 Butterfield Rd Ste 1600
Downers Grove, IL 60515-1211

Other names 1

  • Heather Marshall Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201028003170 TX Practitioner - Physical Therapist in Private Practice 4082024286 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ideal Physical Therapy of Texas LLCGroup PAC ID 0547583809, 359 clinicians

Practice addresses (Care Compare)

1700 E Oltorf St
BLDG 1 Suite 105
Austin, TX 78741-4379
Phone (512) 652-0014

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.48
Improvement activities
40
Cost
71.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1334406TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tillman Physical Therapy & Sports Training Center, Inc CurrentSince Sep 18, 2020 Accepting new patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Nov 9, 2020 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Nov 9, 2020 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

2001 Butterfield Rd
Ste 1600
Downers Grove, IL 60515

1700 E Oltorf St
Ste 105
Austin, TX 78741
Phone (512) 652-0014

10815 Ranch Road 2222
Unit 205
Austin, TX 78730
Phone (512) 975-7379

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

2519 S Lakeline Blvd
Ste 100
Cedar Park, TX 78613
Phone (512) 331-6200

1013 W University Ave
Ste 335
Georgetown, TX 78628
Phone (512) 876-2111

1825 Crystal Falls Pkwy
Ste 150
Leander, TX 78641
Phone (512) 817-5001

17220 N Rm 620 Rd
Ste 110
Round Rock, TX 78681
Phone (512) 527-6007

5400 Brodie Ln
Ste 295
Sunset Valley, TX 78745
Phone (512) 676-3949

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1124630769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BUTTERFIELD RD STE 1600",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 S LAKELINE BLVD STE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132964",
            "telephone_number": "512-331-6200",
            "fax_number": "512-331-6384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSON",
        "first_name": "HEATHER",
        "middle_name": "RENAE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-17",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1334406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "MARSHALL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.