Provider Demographics
NPI:1093858797
Name:BETTS, RUSSELL ARTHUR (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ARTHUR
Last Name:BETTS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 SILVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3919
Mailing Address - Country:US
Mailing Address - Phone:214-585-1025
Mailing Address - Fax:
Practice Address - Street 1:17001 ADDISON RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5027
Practice Address - Country:US
Practice Address - Phone:214-585-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT20782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer