Individual provider Active NPI

Russell Standridge, DPT

  • Physical Therapist
  • Huntsville, AL
National Provider Identifier
1538626577
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTH9522 Issued in AL
Practice address
4601 Whitesburg Dr SE Ste 102
Huntsville, AL 35802-1677
Phone
(256) 883-1734
Fax
(256) 883-1735
NPI assigned
Feb 26, 2019
Last updated
Sep 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X PTH9522 AL Primary

Addresses

Primary practice location

4601 Whitesburg Dr SE Ste 102
Huntsville, AL 35802-1677

Mailing address

PO Box 306393
Nashville, TN 37230-6393
Phone (615) 373-1350

Other practice location 1

1811 Dahlke Dr
Cullman, AL 35058-3625
Phone (256) 739-1370

Other practice location 2

1302 2nd Ave SW Ste F
Cullman, AL 35055-5398
Phone (256) 615-2990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191009001517 AL Practitioner - Physical Therapist in Private Practice 2365773173 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of South Alabama College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agilitas USA, IncGroup PAC ID 3375454648, 812 clinicians

Practice addresses (Care Compare)

1241 Point Mallard Sepkwy
Suite 201
Decatur, AL 35601-6555
Phone (256) 350-9750

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTH9522ALMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Drayer Physical Therapy-Alabama, LLC Physical Therapist CurrentSince Feb 15, 2022 Accepting new patients
Drayer Physical Therapy Alabama LLC CurrentSince Feb 15, 2022 Accepting new patients
Agilitas USA, Inc Physical Therapist CurrentSince Jul 13, 2019 Accepting new patients
Agilitas USA Inc Physical Therapist CurrentSince Jul 13, 2019 Accepting new patients

Locations

1302 2nd Ave SW
#F
Cullman, AL 35055
Phone (256) 615-2990

1811 Dahlke Dr
Cullman, AL 35058
Phone (256) 739-1370

1241 Point Mallard Pkwy
Ste 201
Decatur, AL 35601
Phone (256) 350-9750

2215 Decatur Hwy
Ste 125
Gardendale, AL 35071
Phone (205) 285-8790

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

4601 Whitesburg Dr SE
Ste 102
Huntsville, AL 35802
Phone (256) 883-1734

800 Crescent Centre Dr
Ste 300
Franklin, TN 37067

800 Crescent Centre Dr
Ste 600
Franklin, TN 37067
Phone (615) 416-0199

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1538626577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306393",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306393",
            "telephone_number": "615-373-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 WHITESBURG DR SE STE 102",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358021677",
            "telephone_number": "256-883-1734",
            "fax_number": "256-883-1735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1811 Dahlke Dr",
            "address_purpose": "LOCATION",
            "city": "Cullman",
            "state": "AL",
            "postal_code": "350583625",
            "country_code": "US",
            "telephone_number": "256-739-1370",
            "fax_number": "256-937-7229",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1302 2nd Ave SW Ste F",
            "address_purpose": "LOCATION",
            "city": "Cullman",
            "state": "AL",
            "postal_code": "350555398",
            "country_code": "US",
            "telephone_number": "256-615-2990",
            "fax_number": "256-513-7763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANDRIDGE",
        "first_name": "RUSSELL",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-26",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH9522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.