MEDICARE: ALINA RUSSELL PT

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
1	225100000X	Physical Therapist	2305006075	VA

General Provider Information

NPI Number	:	1194180216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALINA RUSSELL PT

Provider Business Mailing Address
First Line	:	8207 DABNEY AVE
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8207 DABNEY AVE
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1807
Country	:	US
Telephone Number	:	571-276-1039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/16/2015

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