Provider Demographics
NPI:1538496302
Name:ALTMAN, RUSSELL (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:ALTMAN
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 1:10 SUMMIT AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1177
Mailing Address - Country:US
Mailing Address - Phone:908-603-9605
Mailing Address - Fax:908-934-9389
Practice Address - Street 1:10 SUMMIT AVE
Practice Address - Street 2:STE 1
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1177
Practice Address - Country:US
Practice Address - Phone:908-603-9605
Practice Address - Fax:908-934-9389
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01414200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist