Shannon Russell, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61057006 Issued in WA

Practice address

4649 Sunnyside Ave N Ste 302
Seattle, WA 98103-6955

Phone

(206) 588-0855

Fax

(206) 588-0397

NPI assigned

Sep 28, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Andrew Eisen Physical Therapy, LLC

  • Physical Therapist
  • Seattle, WA
  • NPI 1912245192
  NPD

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1124635727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4649 SUNNYSIDE AVE N STE 302",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981036955",
            "telephone_number": "206-588-0855",
            "fax_number": "206-588-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4649 SUNNYSIDE AVE N STE 302",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981036955",
            "telephone_number": "206-588-0855",
            "fax_number": "206-588-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SHANNON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61057006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mathew Russell, LMT
• Naomi Lynn Russell, LMP CCT
• Patrick Joseph Russell, BA, AAC
• Rufus Leon Russell Jr.
• Samuel Guy Russell, MD
• Sharon Russell, LPN
• Stacy Michaela Russell, MD
• Ellery T. Russian, DPT
• Alexandra Russo
• Alfred John Russo, D.A.O.M., L.AC.

• 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 28, 2020; 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.