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General NPI Number Information
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NPI Number | 1902887375
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Entity Type | Individual
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Provider Name | RUSSELL JAMES ANNIS JR. P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1639 N NATIONAL RD
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City | COLUMBUS
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State | IN
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Zip | 47201
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Country | US
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Telephone | 812-669-1687
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Fax | 812-775-1035
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Provider Business Mailing Address
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Address Line | 600 OAKMONT LN STE 600C
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City | WESTMONT
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State | IL
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Zip | 60559-5548
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Country | US
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Telephone | 630-575-6250
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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 | 05003020A
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License Number State | IN
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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 | 2305207421
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License Number State | VA
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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 | PT-04982
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License Number State | OH
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