Active NPI
Russell Edward Huckert, P.T.
- Physical Therapist
- Bethel, AK
National Provider Identifier
1215147756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1569
- Practice address
- 700 Chief Eddie Hoffman Highway
Bethel, AK 99559 - Phone
- (907) 543-6359
- Fax
- (907) 543-6850
- NPI assigned
- May 23, 2007
- Sex
- Male
- 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 Therapist | 225100000X | 1569 | AK | Primary |
Addresses
Primary practice location
700 Chief Eddie Hoffman Highway
Bethel, AK 99559
Mailing address
PO Box 3106
Bethel, AK 99559-3106
Phone (907) 543-4309
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT1569 | Medicaid | AK |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1569 | AK | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1215147756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3106",
"city": "BETHEL",
"state": "AK",
"postal_code": "995593106",
"telephone_number": "907-543-4309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 CHIEF EDDIE HOFFMAN HIGHWAY",
"city": "BETHEL",
"state": "AK",
"postal_code": "99559",
"telephone_number": "907-543-6359",
"fax_number": "907-543-6850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUCKERT",
"first_name": "RUSSELL",
"middle_name": "EDWARD",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AK",
"license": "1569",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PT1569",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.