Active NPI
Russell Medina Gonzales, PT
- Physical Therapist
- Joplin, MO
National Provider Identifier
1740490671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2005028005
- Practice address
- 214 W 5TH St Ste D-E
Joplin, MO 64801-2501 - Phone
- (417) 782-2917
- Fax
- (417) 782-7038
- NPI assigned
- May 22, 2007
- Sex
- Male
- 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 | 2005028005 | MO | Primary |
Addresses
Primary practice location
214 W 5TH St Ste D-E
Joplin, MO 64801-2501
Mailing address
214 W 5TH St Ste D-E
Joplin, MO 64801-2501
Phone (417) 782-2917
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 |
|---|---|---|---|
| 2005028005 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740490671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "214 W 5TH ST STE D-E",
"city": "JOPLIN",
"state": "MO",
"postal_code": "648012501",
"telephone_number": "417-782-2917",
"fax_number": "417-782-7038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 W 5TH ST STE D-E",
"city": "JOPLIN",
"state": "MO",
"postal_code": "648012501",
"telephone_number": "417-782-2917",
"fax_number": "417-782-7038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "RUSSELL",
"middle_name": "MEDINA",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2005028005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joplin, MO
Sources for this page
- 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.