Provider Demographics
NPI:1477743896
Name:DARLEY, RUSSELL DAVID (ATC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DAVID
Last Name:DARLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 DODSON BRANCH RD
Mailing Address - Street 2:APT D-1
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-7550
Mailing Address - Country:US
Mailing Address - Phone:931-646-0773
Mailing Address - Fax:
Practice Address - Street 1:BOX 5102, 1160 N PEACHTREE RM 114
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38505-0001
Practice Address - Country:US
Practice Address - Phone:931-372-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer