Provider Demographics
NPI:1407259567
Name:RUSS, ROBERT (PT MS DPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:RUSS
Suffix:
Gender:M
Credentials:PT MS DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 GAR HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3906
Mailing Address - Country:US
Mailing Address - Phone:508-379-0090
Mailing Address - Fax:508-379-6050
Practice Address - Street 1:1738 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3906
Practice Address - Country:US
Practice Address - Phone:508-379-0090
Practice Address - Fax:508-379-6050
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist