Active NPI
Nancy Deacon Russell, P.T.
- Physical Therapist
- Pasadena, CA
National Provider Identifier
1598887853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 802
- Practice address
- 1030 S Arroyo Pkwy
Suite #109
Pasadena, CA 91105-3214 - Phone
- (626) 593-2283
- Fax
- (626) 593-2284
- NPI assigned
- Apr 5, 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 802 | CA | Primary |
Addresses
Primary practice location
1030 S Arroyo Pkwy
Suite #109
Pasadena, CA 91105-3214
Mailing address
1621 Glyndon Ave
Venice, CA 90291-2923
Phone (310) 993-5298
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 |
|---|---|---|---|
| 802 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303776000000",
"number": "1598887853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 GLYNDON AVE",
"city": "VENICE",
"state": "CA",
"postal_code": "902912923",
"telephone_number": "310-993-5298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 S ARROYO PKWY",
"address_2": "SUITE #109",
"city": "PASADENA",
"state": "CA",
"postal_code": "911053214",
"telephone_number": "626-593-2283",
"fax_number": "626-593-2284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "NANCY",
"middle_name": "DEACON",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-05",
"last_updated": "2011-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.