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General NPI Number Information
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NPI Number | 1912723776
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Entity Type | Organization
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Legal Business Name | RUSSELL PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 208 E MAIN ST
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City | OAK GROVE
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State | LA
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Zip | 71263-2557
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Country | US
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Telephone | 318-282-5468
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Fax |
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Provider Business Mailing Address
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Address Line | 324 PULLTIGHT RD
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City | OAK GROVE
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State | LA
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Zip | 71263-9187
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Country | US
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Telephone | 318-282-5468
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DALTON RUSSELL
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Credential | DPT
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Telephone | 318-282-5468
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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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