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NPI Code Detail

MEDICARE: ANTONINO RUSSO

MEDICARE: ANTONINO RUSSO
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
1225100000XPhysical Therapist1124782TX

General Provider Information

NPI Number : 1922359769
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONINO RUSSO
Provider Business Mailing Address
First Line : 871 OLD ALICE RD STE 600
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78520-8274
Country : US
Telephone Number : 956-541-2102
Fax Number :
Provider Business Practice Location Address
First Line : 871 OLD ALICE RD STE 600
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78520-8274
Country : US
Telephone Number : 956-541-2102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2012
Last Update Date : 09/19/2012

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Directions to “ ANTONINO RUSSO ” Practice Location

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