MEDICARE: BRADLEY P RUSSELL DPT

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	5234	NH
2	225100000X	Physical Therapist	PTL26498	MA
3	225100000X	Physical Therapist	070.025309	IL

General Provider Information

NPI Number	:	1801489828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY P RUSSELL DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:	517-435-3670

Provider Business Practice Location Address
First Line	:	4511 ROUTE 71
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7416
Country	:	US
Telephone Number	:	630-554-7815
Fax Number	:	630-554-4849

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

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	06/16/2026

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Directions to “ BRADLEY P RUSSELL DPT” Practice Location

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