Kallista Russo

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA02283600 Issued in NJ

Practice address

300 Gordons Corner Rd Ste 2
Manalapan, NJ 07726-3150

Phone

(732) 851-7642

NPI assigned

Aug 28, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Kessler Institute for Rehabilitation Inc

  • Rehabilitation Hospital
  • West Orange, NJ
  • NPI 1013919620
  NPD (past)
• Kessler Institute for Rehabilitation, Inc.

  • Rehabilitation Hospital
  • Marlton, NJ
  • NPI 1528512266
  NPD (past)

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

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1548094964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 BAYVIEW DR",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087237461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GORDONS CORNER RD STE 2",
            "city": "MANALAPAN",
            "state": "NJ",
            "postal_code": "077263150",
            "telephone_number": "732-851-7642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "KALLISTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02283600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Roth
• Rovr Medical Corp
• Christine Rowe, MA, CCC-SLP
• RSL Counseling and Coaching LLC
• Corinne Russo, DPT
• Lorena Ruvinova, M.S.CCC-SLP, TSSLD
• RX Express Pharmacy Inc.
• Maureen L Ryan, LCSW
• Carleton I Ryder, LPC
• Stav Sachdev

• Physical Therapist in Manalapan, NJ
• Providers in Manalapan, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.