Active NPI
Russell Pennington
- Physical Therapy Assistant
- Cottage Grove, OR
National Provider Identifier
1225572019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 09348
- Practice address
- 146 Village Drive
Cottage Grove, OR 97424-9544 - Phone
- (541) 228-4086
- NPI assigned
- Dec 13, 2016
- Last updated
- Dec 13, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 09348 | OR | Primary |
Addresses
Primary practice location
146 Village Drive
Cottage Grove, OR 97424-9544
Mailing address
146 Village Dr
Cottage Grove, OR 97424-9544
Phone (541) 228-4086
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09348 | OR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481587200000",
"number": "1225572019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 VILLAGE DR",
"city": "COTTAGE GROVE",
"state": "OR",
"postal_code": "974249544",
"telephone_number": "541-228-4086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 VILLAGE DRIVE",
"city": "COTTAGE GROVE",
"state": "OR",
"postal_code": "974249544",
"telephone_number": "541-228-4086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNINGTON",
"first_name": "RUSSELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-13",
"last_updated": "2016-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "09348",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cottage Grove, OR
- Peacehealth (Cottage Grove Community Medical CT)
- Peacehealth (South Lane Medical Group)
- Peacehealth (Cottage Grove Community Medical CT)
- Mary Peckenpaugh
- Eve Peirce, MS, LPC
- Thea E Petersen, MD
- Planned Parenthood of Southwestern Oregon
- Planned Parenthood of Southwestern Oregon
- Jacob A Pleich, MA, QMHP
- Dennis Gere Polzin Jr., DO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.