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

Individual provider Physical Therapist · NPI 1699343558

Michele Renae Russell, DPT is a Physical Therapist in Private Practice in Lakeside, Arizona. Qualified in 2021, 5 years ago. Practices with Foothills Sports Medicine and Rehabilitation LLC, a 173-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
5
Licensed in
AZ
In the registry since
2021
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

4830 Highway 260 Ste 105
Lakeside, AZ 85929-5851
Phone: (928) 532-1221
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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 31790 (AZ)

Record details

NPI number1699343558
Entity typeIndividual (Type 1)
GenderFemale
Credentials DPT
Sole proprietorNo
NPI enumeratedJune 16, 2021
Last updated in NPPESApril 21, 2022
Certification dateApril 21, 2022

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)
Group practice Foothills Sports Medicine And Rehabilitation Llc — 173 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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