Derick M Russell, MPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Practice address

6326 West Roosevelt Rd
Oak Park, IL 60304

Phone

(708) 691-3562

Fax

(708) 660-9356

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

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)

Enrolled

State licenses

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710907480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 CIRCLE AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302326",
            "telephone_number": "708-691-3562",
            "fax_number": "708-660-9356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6326 WEST ROOSEVELT RD",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "60304",
            "telephone_number": "708-691-3562",
            "fax_number": "708-660-9356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "DERICK",
        "middle_name": "M",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rush-Select Holdings, LLC. (RUSH Physical Therapy)
• Jimmie Earl Rushing
• Sara Marie Rusk, PSY.D.
• Brittany Elise Russell
• Deandranay Russell
• Frank Russo
• Igor Russo, D.C.
• Maureen Bella Russo, MA, ATR-P
• Timothy Morgan Russo, CPO
• Nancy Joan Ryan, OTR/L

• Orthopedic Physical Therapist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Orthopedic Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.