Active NPI
Marci Kae Russell, PT
- Physical Therapist
- Clinton, OK
National Provider Identifier
1770708034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2547
- Practice address
- 1930 W Gary Blvd
Clinton, OK 73601-3838 - Phone
- (580) 323-8778
- NPI assigned
- Apr 13, 2007
- 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 | 2547 | OK | Primary |
Addresses
Primary practice location
1930 W Gary Blvd
Clinton, OK 73601-3838
Mailing address
1930 W Gary Blvd
Clinton, OK 73601-3838
Phone (580) 323-8778
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 |
|---|---|---|---|
| 2547 | OK | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therawest LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770708034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 W GARY BLVD",
"city": "CLINTON",
"state": "OK",
"postal_code": "736013838",
"telephone_number": "580-323-8778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1930 W GARY BLVD",
"city": "CLINTON",
"state": "OK",
"postal_code": "736013838",
"telephone_number": "580-323-8778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "MARCI",
"middle_name": "KAE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "2547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, OK
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.