Provider Demographics
NPI:1114350576
Name:RUSSELL, BYRON EDWARD (PT)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:EDWARD
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 NORTH RIVERPOINT BLVD
Mailing Address - Street 2:BOX V
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1675
Mailing Address - Country:US
Mailing Address - Phone:509-828-1323
Mailing Address - Fax:509-368-6890
Practice Address - Street 1:310 NORTH RIVERPOINT BLVD
Practice Address - Street 2:BOX V
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1675
Practice Address - Country:US
Practice Address - Phone:509-828-1323
Practice Address - Fax:509-368-6890
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00007695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist