Michele Renae Russell, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

31790 Issued in AZ

Practice address

4830 Highway 260 Ste 105
Lakeside, AZ 85929-5851

Phone

(928) 532-1221

NPI assigned

Jun 16, 2021

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

Other names 1

• Michele Renae Clark Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foothills Sports Medicine and Rehabilitation LLCGroup PAC ID 2668457979, 172 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Foothills Sports Medicine & Rehabilitation, LLC

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1558318170
  Medicare reassignment Care Compare group NPD
• White Mountain Physical Therapy LTD

  • Physical Therapist
  • Show Low, AZ
  • NPI 1750385654
  Medicare reassignment NPD
• Foothills Sports Medicine & Rehabilitation, LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1073224267
  NPD

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1699343558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859290658",
            "telephone_number": "928-242-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4830 HIGHWAY 260 STE 105",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295851",
            "telephone_number": "928-532-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MICHELE",
        "middle_name": "RENAE",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-16",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "31790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELE",
            "last_name": "CLARK",
            "middle_name": "RENAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Roger Williams MD PC
• Samuel Jesus Rosero Garcia, M.D.
• Rta Hospice, LLC
• Robert J Russ, S.T.S.A.
• Antoinette Russell
• Safeway Inc (Safeway Pharmacy #2069)
• Guerline Saintfleur
• San Tan Behavioral Health Services
• San Tan Behavioral Health Services
• Savannah Pain Relief, LLC

• Physical Therapist in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.