Individual provider Active NPI

Frank T Russo, PT, DPT

  • Physical Therapist
  • North Myrtle Beach, SC
National Provider Identifier
1164259552
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
052834 Issued in NY
Practice address
1621 Highway 17 N
North Myrtle Beach, SC 29582-2229
Phone
(843) 353-3460
Fax
(843) 353-3461
NPI assigned
Sep 18, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 12580 SC
Physical Therapist 225100000X 052834 NY Primary

Addresses

Primary practice location

1621 Highway 17 N
North Myrtle Beach, SC 29582-2229

Mailing address

210 Village Center Blvd Ste 140
Myrtle Beach, SC 29579-6706
Phone (843) 353-3460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250108001491 SC Practitioner - Physical Therapist in Private Practice 0941738702 Reassigns benefits to 1 organization
I20250421001268 NY Practitioner - Physical Therapist in Private Practice 0941738702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2024
Medicare assignment
May accept Medicare assignment
Group practices
J. Lamendola Physical Therapy, P.C.Group PAC ID 6800141565, 13 clinicians

Practice addresses (Care Compare)

7524 3Rd Ave
Brooklyn, NY 11209-3104
Phone (718) 816-6500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
052834NYMDPharmacist
12580SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthosc, LLC Multi-Specialty CurrentSince Dec 2, 2024 Accepting new patients
J. Lamendola Physical Therapy, P.C. Multi-Specialty CurrentSince May 12, 2025 Accepting new patients
Orthosc, LLC Multi-Specialty CurrentSince Dec 2, 2024 Accepting new patients
J P L TLC 76 &3 Corp CurrentSince May 12, 2025 Accepting new patients
One on One Physical Therapy Services PLLC Multi-Specialty PastSince Apr 16, 2025 Accepting new patients
MFS Orthopedics PC Multi-Specialty PastSince Jul 5, 2020 Accepting new patients
Orthosc, LLC PastSince May 29, 2022 Accepting new patients

Locations

7524 3rd Ave
Brooklyn, NY 11209

1297 Clove Rd
Staten Island, NY 10301
Phone (718) 447-8060

236 Richmond Valley Rd
Ste 16
Staten Island, NY 10309

2376 Cypress Cir
Ste 300
Conway, SC 29526
Phone (843) 347-7222

210 Village Center Blvd
Ste 140
Myrtle Beach, SC 29579
Phone (843) 333-8385

210 Village Center Blvd
Ste 100
Myrtle Beach, SC 29579
Phone (843) 491-4937

1621 Highway 17 N
North Myrtle Beach, SC 29582
Phone (843) 335-3346

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17161/brand/1/csg/1/fhir/r4

Organizations & group practices 7

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": "1726617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1164259552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 VILLAGE CENTER BLVD STE 140",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295796706",
            "telephone_number": "843-353-3460",
            "fax_number": "843-353-3461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 HIGHWAY 17 N",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295822229",
            "telephone_number": "843-353-3460",
            "fax_number": "843-353-3461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "FRANK",
        "middle_name": "T",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "12580",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "052834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.