Active NPI
Angela Russell, MSPT
- Specialist
- Little Rock, AR
National Provider Identifier
1588798235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT#2213
- Practice address
- 8109 Interstate 30
Little Rock, AR 72209-4840 - Phone
- (501) 249-7413
- NPI assigned
- Mar 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | PT#2213 | AR | Primary |
Addresses
Primary practice location
8109 Interstate 30
Little Rock, AR 72209-4840
Mailing address
4 Park Dr
Bryant, AR 72022-2940
Phone (501) 249-7413
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 |
|---|---|---|---|
| PT#2213 | AR | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Full Potential | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686009600000",
"number": "1588798235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 PARK DR",
"city": "BRYANT",
"state": "AR",
"postal_code": "720222940",
"telephone_number": "501-249-7413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8109 INTERSTATE 30",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722094840",
"telephone_number": "501-249-7413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ANGELA",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-15",
"last_updated": "2023-06-06",
"certification_date": "2023-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AR",
"license": "PT#2213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.