Healthcare Provider Details

I. General information

NPI: 1639864291
Provider Name (Legal Business Name): BARBARA ANN RUSSELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 BRIDGETOWN RD
CINCINNATI OH
45211-4428
US

IV. Provider business mailing address

200 PLEASANT HILL RD
GADSDEN AL
35904-6564
US

V. Phone/Fax

Practice location:
  • Phone: 513-574-4550
  • Fax:
Mailing address:
  • Phone: 256-624-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: