Theresa Delores Russell PTA

NPI 1023372992 - Physical Therapy Assistant - 225200000X

NPI Details
NPI 1023372992
Gender Female
Enumeration Date 06/26/2012
Last Updated 06/26/2012
Entity Type Individual
Active Over 4 years ago
Practice Location
11577 RIO SECCO RD
PEYTON CO, 80831-4031, US
Phone (757) 450-5773
Fax
Business Location
11577 RIO SECCO RD
PEYTON CO, 80831-4031, US
Phone (757) 450-5773
Fax
Toxanomy
Taxonomy Code 225200000X
License State Colorado
License Number 12203
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According to our database, Mrs. Theresa Delores Russell PTA NPI is 1023372992, taxonomy code is 225200000X and license number is 12203, license state is located at Colorado. Theresa Delores Russell PTA physically located at 11577 Rio Secco Rd, Peyton CO, 80831-4031. NPI Number Theresa Delores Russell PTA has the Individual type.

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1023372992 NPI number is provided on an as is basis without warranty of any kind. 1023372992 is maintained by the National Plan & Provider Enumeration System. The contents of Theresa Delores Russell PTA are for informational purposes only.