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NPI Code Detail

MEDICARE: JOSEPH DANIEL RUSSELL DPT

MEDICARE: JOSEPH DANIEL RUSSELL DPT
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
1225100000XPhysical Therapist26655FL

General Provider Information

NPI Number : 1194446625
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH DANIEL RUSSELL DPT
Provider Business Mailing Address
First Line : 9912 HAROLD BEDFORD RD
Second Line :
City : RIVERVIEW
State : FL
Zip : 33578-7659
Country : US
Telephone Number : 813-610-3618
Fax Number :
Provider Business Practice Location Address
First Line : 912 AMERICAN EAGLE BLVD
Second Line :
City : SUN CITY CENTER
State : FL
Zip : 33573-5228
Country : US
Telephone Number : 813-633-3066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2022
Last Update Date : 09/02/2022

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