Active NPI
Abigail Russell
- Physical Therapist
- Monroe, GA
National Provider Identifier
1750491817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 142 Ga State Highway 138
Monroe, GA 30655 - Phone
- (770) 207-1137
- NPI assigned
- Aug 30, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
142 Ga State Highway 138
Monroe, GA 30655
Mailing address
1016 Granite LN
Loganville, GA 30052-2377
Phone (770) 554-6750
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA001474 | Other | GA | LICENSE# |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750491817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 GRANITE LN",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300522377",
"telephone_number": "770-554-6750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "142 GA STATE HIGHWAY 138",
"city": "MONROE",
"state": "GA",
"postal_code": "30655",
"telephone_number": "770-207-1137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ABIGAIL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE#",
"identifier": "PTA001474",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, GA
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.