Provider Demographics
NPI:1104040484
Name:RUSS, RICHARD DEAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEAN
Last Name:RUSS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MORTIMER LN
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-9497
Mailing Address - Country:US
Mailing Address - Phone:724-375-2904
Mailing Address - Fax:
Practice Address - Street 1:971 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2046
Practice Address - Country:US
Practice Address - Phone:724-774-8470
Practice Address - Fax:724-774-8471
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33007373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist