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General NPI Number Information
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NPI Number | 1295452837
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Entity Type | Organization
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Legal Business Name | DAVID RUSSAK PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 14748 HARTSOOK ST
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1407
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Country | US
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Telephone | 818-309-3630
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Fax |
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Provider Business Mailing Address
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Address Line | 5737 KANAN RD # 114
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City | AGOURA HILLS
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State | CA
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Zip | 91301-1601
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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 | OWNER
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Name | DAVID RUSSAK
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Credential |
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Telephone | 818-309-3630
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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 |
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License Number State |
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