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NPI Code Detail

MEDICARE: HOWARD MICHAEL RUSSELL LPT

MEDICARE: HOWARD MICHAEL RUSSELL LPT
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 Therapist0287OR
2225100000XPhysical TherapistPT1338ID

General Provider Information

NPI Number : 1336211226
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOWARD MICHAEL RUSSELL LPT
Provider Business Mailing Address
First Line : PO BOX 198
Second Line :
City : HARRISON
State : ID
Zip : 83833-0198
Country : US
Telephone Number : 208-755-5704
Fax Number : 208-689-3183
Provider Business Practice Location Address
First Line : 3325 POCAHONTAS ROAD
Second Line : ST ELIZABETH HEALTH SERVICES
City : BAKER CITY
State : ID
Zip : 97814-1464
Country : US
Telephone Number : 541-523-8130
Fax Number : 541-523-1793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 07/08/2007

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Directions to “ HOWARD MICHAEL RUSSELL LPT” Practice Location

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