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General NPI Number Information
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NPI Number | 1699148783
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Entity Type | Individual
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Provider Name | DANYELL RUSSELL DPT
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Gender | Female
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 3001 FM 2181 150
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City | CORINTH
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State | TX
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Zip | 76210-2101
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Country | US
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Telephone | 940-498-4004
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Fax | 940-498-4008
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Provider Business Mailing Address
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Address Line | 1900 LONG PRAIRIE RD 104
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4217
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Country | US
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Telephone | 972-724-2400
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Fax | 972-724-2495
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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 | 1252060
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License Number State | TX
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