NPIMap

Organization Active NPI

Susy Russell Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Charlottesville, VA
National Provider Identifier
1902161672
Registry record updated Oct 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
2305003603 Issued in VA
Legal business name
SUSY RUSSELL PHYSICAL THERAPY LLC
Practice address
3040 Berkmar Dr Ste A1
Charlottesville, VA 22901-1593
Phone
(434) 249-9578
NPI assigned
Jul 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susanne Russell, MSPTNPI 1508083155
Title
Owner
Phone
(434) 249-9578

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 2305003603 VA Primary

Addresses

Primary practice location

3040 Berkmar Dr Ste A1
Charlottesville, VA 22901-1593

Mailing address

3040 Berkmar Dr Ste A1
Charlottesville, VA 22901-1593
Phone (434) 249-9578

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120723000369 VA Part B Supplier - Clinic/Group Practice 9537325477 Receives reassigned benefits from 1 practitioner
Practice locations: Charlottesville, VA

National Provider Directory

National Provider Directory

Locations

3040 Berkmar Dr
Ste A1
Charlottesvle, VA 22901
Phone (434) 249-9578

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1902161672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 BERKMAR DR STE A1",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229011593",
            "telephone_number": "434-249-9578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 BERKMAR DR STE A1",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229011593",
            "telephone_number": "434-249-9578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSY RUSSELL PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "434-249-9578",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "VA",
            "license": "2305003603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.