Provider Demographics
NPI:1184855538
Name:FOXE, RUSSELL THOMAS (PT,DPT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:THOMAS
Last Name:FOXE
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5956 E PIMA ST STE 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4385
Mailing Address - Country:US
Mailing Address - Phone:520-885-4636
Mailing Address - Fax:520-885-4736
Practice Address - Street 1:5956 E PIMA ST STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4385
Practice Address - Country:US
Practice Address - Phone:520-885-4636
Practice Address - Fax:520-885-4736
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8574OtherARIZONA STATE BOARD OF PHYSICAL THERAPY