MEDICARE: MS. ALISON N RUSSELL P.T.

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	PT00010222	WA
2	225100000X	Physical Therapist	8080	AZ

General Provider Information

NPI Number	:	1699870279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALISON N RUSSELL P.T.

Provider Business Mailing Address
First Line	:	7430 E PINNACLE PEAK RD
Second Line	:	SUITE #138
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-3630
Country	:	US
Telephone Number	:	480-502-4324
Fax Number	:	480-502-1397

Provider Business Practice Location Address
First Line	:	7430 E PINNACLE PEAK RD
Second Line	:	SUITE #138
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-3630
Country	:	US
Telephone Number	:	480-502-4324
Fax Number	:	480-502-1397

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/16/2012

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