Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nicole Renee Russo, PT, DPT

Individual provider Physical Therapist · NPI 1972997633

Nicole Renee Russo, PT, DPT is a Physical Therapist in Private Practice in Hackensack, New Jersey. Qualified in 2015, 11 years ago. Practices with Ivyrehab Network Inc, a 653-clinician group and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
11
Licensed in
NJ
In the registry since
2015
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

605 Main St
Hackensack, NJ 07601-5914
Phone: (201) 488-0488
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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 40QA01599400 (NJ)

Record details

NPI number1972997633
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT , DPT
Sole proprietorYes
NPI enumeratedMarch 20, 2015
Last updated in NPPESFebruary 13, 2024
Certification dateFebruary 13, 2024

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Ivyrehab Network Inc — 653 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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