Active NPI
Shannon Lynn Russell, DPT
- Physical Therapist
- Robbinsville, NJ
National Provider Identifier
1396402855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA02049300
- Practice address
- 5 Beverly CT
Robbinsville, NJ 08691-1332 - Phone
- (609) 436-9089
- NPI assigned
- Nov 19, 2021
- Sex
- Female
- 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 | 40QA02049300 | NJ | Primary |
Addresses
Primary practice location
5 Beverly CT
Robbinsville, NJ 08691-1332
Mailing address
5 Beverly CT
Robbinsville, NJ 08691-1332
Phone (609) 436-9089
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 |
|---|---|---|---|
| 40QA02049300 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637280000000",
"number": "1396402855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 BEVERLY CT",
"city": "ROBBINSVILLE",
"state": "NJ",
"postal_code": "086911332",
"telephone_number": "609-436-9089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 BEVERLY CT",
"city": "ROBBINSVILLE",
"state": "NJ",
"postal_code": "086911332",
"telephone_number": "609-436-9089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "SHANNON",
"middle_name": "LYNN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-19",
"last_updated": "2021-11-19",
"certification_date": "2021-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA02049300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Robbinsville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.