MEDICARE: RUSSELL MARLOWE

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	225200000X	Physical Therapy Assistant	PTA003301	GA

General Provider Information

NPI Number	:	1437542057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL MARLOWE

Provider Business Mailing Address
First Line	:	PO BOX 801
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-0018
Country	:	US
Telephone Number	:	706-207-8185
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 WASHINGTON HWY
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669-2821
Country	:	US
Telephone Number	:	706-207-8185
Fax Number	:

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

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/05/2015

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Directions to “ RUSSELL MARLOWE ” Practice Location

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