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General NPI Number Information
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NPI Number | 1225698210
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Entity Type | Individual
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Provider Name | ALEX W RUSSELL PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 701 N WALTON BLVD STE 2
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City | BENTONVILLE
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State | AR
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Zip | 72712-4548
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Country | US
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Telephone | 479-250-9838
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Fax |
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Provider Business Mailing Address
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Address Line | 9 MAY LN
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City | BELLA VISTA
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State | AR
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Zip | 72715-4804
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Country | US
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Telephone | 505-917-3911
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1324750
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License Number State | TX
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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 | PT5503
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5415
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License Number State | AR
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