Healthcare Provider Details

I. General information

NPI: 1649537168
Provider Name (Legal Business Name): CHRISTINE ANN RUSSO DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2012
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N HANDY ST
ORANGE CA
92867-4434
US

IV. Provider business mailing address

1401 N HANDY ST
ORANGE CA
92867-4434
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-4080
  • Fax:
Mailing address:
  • Phone: 714-628-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: