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

Domenick Russolello

Individual provider Physical Therapist · NPI 1750836078

Domenick Russolello is a Physical Therapist in Private Practice in Lagrangeville, New York. Qualified in 2016, 10 years ago. Practices with Elevate Holding Company, LLC, a 27-clinician group. Licensed in New York.

Years since qualifying
10
Licensed in
NY
In the registry since
2016
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Practice location Address checks out

1141 Route 55 Ste A
Lagrangeville, NY 12540-5005
Phone: (845) 895-1115
Fax: (845) 895-1116
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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 040777 (NY)

Record details

NPI number1750836078
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 16, 2016
Last updated in NPPESAugust 16, 2016
Mailing address16 Maybrook Rd, Ste A, Campbell Hall, NY 10916-2743

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Elevate Holding Company, Llc — 27 clinicians
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Lagrangeville