Active NPI
Bradley Russell, DPT
- Physical Therapist
- Verona, WI
National Provider Identifier
1902459613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14739-24
- Practice address
- 416 E Verona Ave
Verona, WI 53593-1227 - Phone
- (608) 848-6628
- Fax
- (608) 848-6629
- NPI assigned
- Jul 22, 2019
- Sex
- Male
- 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 | 14739-24 | WI | Primary |
Addresses
Primary practice location
416 E Verona Ave
Verona, WI 53593-1227
Mailing address
416 E Verona Ave
Verona, WI 53593-1227
Phone (608) 848-6628
Other practice location 1
1266 W Main St
Sun Prairie, WI 53590-1918
Phone (608) 318-1357
Other practice location 2
3525 University Ave
Madison, WI 53705-2140
Phone (608) 467-3537
Other practice location 3
1215 Springdale St
Mount Horeb, WI 53572-2016
Phone (608) 437-0222
Other practice location 4
223 S Century Ave
Waunakee, WI 53597-1249
Phone (608) 850-7275
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14739-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563753600000",
"number": "1902459613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 E VERONA AVE",
"city": "VERONA",
"state": "WI",
"postal_code": "535931227",
"telephone_number": "608-848-6628",
"fax_number": "608-848-6629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 E VERONA AVE",
"city": "VERONA",
"state": "WI",
"postal_code": "535931227",
"telephone_number": "608-848-6628",
"fax_number": "608-848-6629"
}
],
"practiceLocations": [
{
"address_1": "1266 W Main St",
"address_purpose": "LOCATION",
"city": "Sun Prairie",
"state": "WI",
"postal_code": "535901918",
"country_code": "US",
"telephone_number": "608-318-1357",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3525 University Ave",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "537052140",
"country_code": "US",
"telephone_number": "608-467-3537",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1215 Springdale St",
"address_purpose": "LOCATION",
"city": "Mount Horeb",
"state": "WI",
"postal_code": "535722016",
"country_code": "US",
"telephone_number": "608-437-0222",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "223 S Century Ave",
"address_purpose": "LOCATION",
"city": "Waunakee",
"state": "WI",
"postal_code": "535971249",
"country_code": "US",
"telephone_number": "608-850-7275",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RUSSELL",
"first_name": "BRADLEY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-22",
"last_updated": "2019-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "14739-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Verona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.