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General NPI Number Information
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NPI Number | 1083832208
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Entity Type | Individual
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Provider Name | RUSSELL PATRICK SARAULT III DPT
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 132 E PULASKI HWY
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City | ELKTON
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State | MD
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Zip | 21921-6430
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Country | US
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Telephone | 443-671-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-497-0005
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Fax | 215-629-5531
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018622
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30032
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License Number State | MD
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