Amanda Didawick Russell

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P20626 Issued in NC

Practice address

103 Sleepy Dr Ste G
Spring Lake, NC 28390-3319

Phone

(910) 423-5622

Fax

(910) 378-1755

NPI assigned

Aug 30, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Benefit Therapy Services, PLLC

  • Speech-Language Pathologist
  • Holly Springs, NC
  • NPI 1275994113
  Medicare reassignment NPD
• Therapy Playground, Inc

  • Speech-Language Pathologist
  • Fayetteville, NC
  • NPI 1467433680
  NPD (past)
• Therapy Playground, Inc

  • Physical Therapy Clinic/Center
  • Spring Lake, NC
  • NPI 1528552007
  NPD (past)

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1124795802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4602 CUMBERLAND RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283062412",
            "telephone_number": "910-423-5622",
            "fax_number": "910-378-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SLEEPY DR STE G",
            "city": "SPRING LAKE",
            "state": "NC",
            "postal_code": "283903319",
            "telephone_number": "910-423-5622",
            "fax_number": "910-378-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "AMANDA",
        "middle_name": "DIDAWICK",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-30",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P20626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "therapyplayground.raintreeinc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4602 Cumberland Rd",
            "city": "Fayetteville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283062412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jekhia Danae Robinson
• Kenya Rodgers, CERT HAIRLOSS SPEC
• Joseph Rogers
• Sarah Rorie
• Hamid Rouhani
• Ryan, James, Wiles, Patel & Olsen LLP
• S & H Nursing
• Patricia Isabel Sanchez
• Sandhills Counseling Associates, PLLC
• Jenny Lee Satsatin, LMT

• Physical Therapist in Spring Lake, NC
• Providers in Spring Lake, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.