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General NPI Number Information
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NPI Number | 1114679859
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Entity Type | Individual
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Provider Name | FABRIZIO RUSSO DPT
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Gender | Male
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 28 W FLAGLER ST
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City | MIAMI
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State | FL
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Zip | 33130-1806
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Country | US
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Telephone | 305-331-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 28 W FLAGLER ST STE 901
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City | MIAMI
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State | FL
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Zip | 33130-1894
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Country | US
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Telephone |
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Fax |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PT36494
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License Number State | FL
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