Active NPI
Russell D Gannon, MSPT
- Orthopedic Physical Therapist
- Birmingham, AL
National Provider Identifier
1376643882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- PTH3502
- Practice address
- 616 Gadsden Hwy
Suite a
Birmingham, AL 35235-2501 - Phone
- (205) 833-0881
- Fax
- (205) 833-1190
- NPI assigned
- Sep 24, 2006
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | PTH3502 | AL | Primary |
Addresses
Primary practice location
616 Gadsden Hwy
Suite a
Birmingham, AL 35235-2501
Mailing address
548 Twin Branch Dr
Birmingham, AL 35226-2342
Phone (205) 823-4236
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 |
|---|---|---|---|
| PTH3502 | AL | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376643882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "548 TWIN BRANCH DR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352262342",
"telephone_number": "205-823-4236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "616 GADSDEN HWY",
"address_2": "SUITE A",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352352501",
"telephone_number": "205-833-0881",
"fax_number": "205-833-1190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "RUSSELL",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "AL",
"license": "PTH3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.