Active NPI
Russell Ewbank
- Physical Therapy Assistant
- Brawley, CA
National Provider Identifier
1992683684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 52121
- Practice address
- 409 W Main St
Brawley, CA 92227-2244 - Phone
- (760) 925-3031
- NPI assigned
- Aug 22, 2025
- 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 Therapy Assistant | 225200000X | 52121 | CA | Primary |
Addresses
Primary practice location
409 W Main St
Brawley, CA 92227-2244
Mailing address
1134 S 8TH St
El Centro, CA 92243-3968
Phone (619) 961-6156
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 |
|---|---|---|---|
| 52121 | CA | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MDRS Spine & Sport, Inc | Past | Accepting new patients | |
| MDRS Spine & Sport, Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755820800000",
"number": "1992683684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1134 S 8TH ST",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922433968",
"telephone_number": "619-961-6156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 W MAIN ST",
"city": "BRAWLEY",
"state": "CA",
"postal_code": "922272244",
"telephone_number": "760-925-3031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWBANK",
"first_name": "RUSSELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-22",
"last_updated": "2025-08-22",
"certification_date": "2025-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "52121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brawley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.