Active NPI
David Scott Russo
- Physical Therapist
- Erie, PA
National Provider Identifier
1356069132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT030747
- Practice address
- 2101 Nagle Rd
Erie, PA 16510-2189 - Phone
- (814) 877-7078
- NPI assigned
- Aug 18, 2022
- 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 | PT030747 | PA | Primary |
Addresses
Primary practice location
2101 Nagle Rd
Erie, PA 16510-2189
Mailing address
2101 Nagle Rd
Erie, PA 16510-2189
Phone (814) 877-7078
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 |
|---|---|---|---|
| PT030747 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660780800000",
"number": "1356069132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 NAGLE RD",
"city": "ERIE",
"state": "PA",
"postal_code": "165102189",
"telephone_number": "814-877-7078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 NAGLE RD",
"city": "ERIE",
"state": "PA",
"postal_code": "165102189",
"telephone_number": "814-877-7078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "DAVID",
"middle_name": "SCOTT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-18",
"last_updated": "2022-08-18",
"certification_date": "2022-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT030747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.