Most Relevant Information
Provider Data
| NPI Number: | 1003012980 |
| Provider Name: | MICHAEL D RUSSELL PT,DPT, CSCS |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 2143 |
Most Important Dates
| Enumeration Date: | 06/26/2007 |
| Last Updated: | 07/06/2022 |
Provider Practice Location
3005 W HORIZON RIDGE PKWY STE 101
HENDERSON
NV
890525030
Practice Location Phone/Fax
| Phone: | 7028402500 |
| Fax: | 7252341515 |
Provider Mailing Location
3005 W HORIZON RIDGE PKWY STE 101
HENDERSON
NV
890525030
Provider Mailing Phone/Fax
| Phone: | 7028402500 |
| Fax: | 7252341515 |