Russell John Wareham, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06002776A Issued in IN

Practice address

6002 E 38TH St
Indianapolis, IN 46226-5614

Phone

(317) 880-0280

NPI assigned

May 28, 2024

Sex

Male

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

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

{
    "created_epoch": "1716854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1619717816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 ESKENAZI AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025187",
            "telephone_number": "317-880-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6002 E 38TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462265614",
            "telephone_number": "317-880-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAREHAM",
        "first_name": "RUSSELL",
        "middle_name": "JOHN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-28",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06002776A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• B. Jermaine Ware, D.C.
• Cherelle L Ware
• Joe Anthony Ware, MD
• Kimberly Ann Ware, MSN, RN, AGCNS-BC
• Stephanie M Ware, MD, PHD
• Teresa Dawn Warfel
• Charles A. Warfield, LCSW
• Katelyn Wargel-Fisk, PHD
• Eric Adam Wargel, PHARM.D.
• Judith Gail Warkentien, MS EDU/SPEECH ENDORS

• Physical Therapy Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physical Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.