Provider Demographics
NPI:1073706552
Name:RUSSAK, KRISTY A (RPT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:A
Last Name:RUSSAK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1302
Mailing Address - Country:US
Mailing Address - Phone:215-500-5440
Mailing Address - Fax:
Practice Address - Street 1:218 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1302
Practice Address - Country:US
Practice Address - Phone:215-500-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist