MEDICARE: JMF WELLNESS LLC PURE PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1003700188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMF WELLNESS LLC PURE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3950 HALIFAX RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5448
Country	:	US
Telephone Number	:	910-216-4887
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 1/2 OLEANDER DR STE 102
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6806
Country	:	US
Telephone Number	:	330-518-7219
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PT
Name	:	JENNIFER RAE RUSSO
Credential	:	DPT
Telephone Number	:	910-216-4887

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	02/18/2026

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