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General NPI Number Information
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NPI Number | 1639563950
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Entity Type | Organization
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Legal Business Name | RUSSO PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 4266 ACME RD
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City | FRANKFORT
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State | NY
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Zip | 13340-3504
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Country | US
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Telephone | 315-507-3828
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Fax |
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Provider Business Mailing Address
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Address Line | 4266 ACME RD
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City | FRANKFORT
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State | NY
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Zip | 13340-3504
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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 | ROBERT RUSSO
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Credential | PT
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Telephone | 315-507-3828
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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 | 0280701
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License Number State | NY
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