Provider Demographics
NPI:1477746857
Name:RUSSELL, WILLIAM JOSEPH JR (MPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:RUSSELL
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:12001 PACIFIC AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5101
Mailing Address - Country:US
Mailing Address - Phone:253-531-8595
Mailing Address - Fax:253-531-6607
Practice Address - Street 1:12001 PACIFIC AVE S STE 101
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5101
Practice Address - Country:US
Practice Address - Phone:253-531-8595
Practice Address - Fax:253-531-6607
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000080632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic