Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Antonino Roberto Russo

Individual provider Physical Therapist · NPI 1316604937

Antonino Roberto Russo is a Physical Therapist in Private Practice in Burley, Idaho. Qualified in 2021, 5 years ago. Licensed in Idaho.

Years since qualifying
5
Licensed in
ID
In the registry since
2021
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Practice location Address checks out

1945 Hiland Ave
Burley, ID 83318-2714
Phone: (208) 647-0024
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT-7636 (ID)

Record details

NPI number1316604937
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 18, 2021
Last updated in NPPESNovember 18, 2021
Certification dateNovember 18, 2021
Mailing address1411 Falls Ave E Ste 401, Twin Falls, ID 83301-3455

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated

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