Active NPI
Shelly Diane Rusin, PTA
- Physical Therapy Assistant
- Waverly, NY
National Provider Identifier
1891287967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 010552-1
- Practice address
- 37 N Chemung St
Waverly, NY 14892-1211 - Phone
- (607) 565-6259
- NPI assigned
- Jun 4, 2018
- 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 Therapy Assistant | 225200000X | 010552-1 | NY | Primary |
Addresses
Primary practice location
37 N Chemung St
Waverly, NY 14892-1211
Mailing address
37 N Chemung St
Waverly, NY 14892-1211
Phone (607) 565-6259
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 |
|---|---|---|---|
| 010552-1 | NY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528070400000",
"number": "1891287967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 N CHEMUNG ST",
"city": "WAVERLY",
"state": "NY",
"postal_code": "148921211",
"telephone_number": "607-565-6259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 N CHEMUNG ST",
"city": "WAVERLY",
"state": "NY",
"postal_code": "148921211",
"telephone_number": "607-565-6259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSIN",
"first_name": "SHELLY",
"middle_name": "DIANE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-04",
"last_updated": "2018-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "010552-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waverly, NY
- James W Peterson
- Joseph Anthony Picco, DDS
- Madison Reynolds
- Monica Robinson
- Wendy Michelle Rogers, LPN
- Marjorie Sampson, LICENSED MASSAGE THE
- Thomas Sampson, MASSAGE THERAPIST
- Donald Sassman, RPH
- Sensational Kids Physical, Occupational & Speech Therapy Services PLLC
- Sensational Kids Physical, Occupational & Speech Therapy Services PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.