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NPI Code Detail

MEDICARE: MRS. SARAH RUTH RUSSELL LPTA

MEDICARE: MRS. SARAH RUTH RUSSELL LPTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant160003016IL

General Provider Information

NPI Number : 1033471545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARAH RUTH RUSSELL LPTA
Provider Business Mailing Address
First Line : 270 CIRCLE DR
Second Line :
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-3302
Country : US
Telephone Number : 618-398-1063
Fax Number : 618-344-9356
Provider Business Practice Location Address
First Line : 601 W LINCOLN AVE
Second Line :
City : CASEYVILLE
State : IL
Zip : 62232-1306
Country : US
Telephone Number : 618-344-9355
Fax Number : 618-344-9356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2012
Last Update Date : 06/11/2012

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