MEDICARE: MS. ANNMARIE S RUSSO

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	0372	NH

General Provider Information

NPI Number	:	1457658403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNMARIE S RUSSO

Provider Business Mailing Address
First Line	:	11 NEW CASTLE ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-2288
Country	:	US
Telephone Number	:	603-225-2181
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 NEW CASTLE ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-2288
Country	:	US
Telephone Number	:	603-225-2181
Fax Number	:

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

Provider Enumeration Date	:	02/26/2011
Last Update Date	:	02/26/2011

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