Healthcare Provider Details

I. General information

NPI: 1962123836
Provider Name (Legal Business Name): KITRICK RUSSELL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TIMBER DR E
GARNER NC
27529-6925
US

IV. Provider business mailing address

1714 CANTERBURY RD
RALEIGH NC
27608-1110
US

V. Phone/Fax

Practice location:
  • Phone: 919-213-0504
  • Fax: 919-981-9213
Mailing address:
  • Phone: 919-213-0504
  • Fax: 919-981-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: