MEDICARE: MR. RUSSELL JAMES ANNIS JR. 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	05003020A	IN
2	225100000X	Physical Therapist	2305207421	VA
3	225100000X	Physical Therapist	PT-04982	OH

General Provider Information

NPI Number	:	1902887375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL JAMES ANNIS JR. P.T.

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201
Country	:	US
Telephone Number	:	812-669-1687
Fax Number	:	812-775-1035

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	04/11/2019

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Directions to “ MR. RUSSELL JAMES ANNIS JR. P.T.” Practice Location

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