MEDICARE: RUSSELL DRAPIZA

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

General Provider Information

NPI Number	:	1417609140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL DRAPIZA

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4935 PT FSDICK DR NW STE 200&300
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1851
Country	:	US
Telephone Number	:	253-258-3355
Fax Number	:

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

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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Directions to “ RUSSELL DRAPIZA ” Practice Location

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