Provider Demographics
NPI:1437542057
Name:MARLOWE, RUSSELL
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:MARLOWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0018
Mailing Address - Country:US
Mailing Address - Phone:706-207-8185
Mailing Address - Fax:
Practice Address - Street 1:1321 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:UNION POINT
Practice Address - State:GA
Practice Address - Zip Code:30669-2821
Practice Address - Country:US
Practice Address - Phone:706-207-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003301225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant