Provider Demographics
NPI:1558896845
Name:DARRINGTON, RUSSELL LYLE (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:LYLE
Last Name:DARRINGTON
Suffix:
Gender:M
Credentials:MS, PT
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Mailing Address - Street 1:1028 REDWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6102
Mailing Address - Country:US
Mailing Address - Phone:972-532-6552
Mailing Address - Fax:972-232-2310
Practice Address - Street 1:907 N GOLIAD ST STE 1
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2230
Practice Address - Country:US
Practice Address - Phone:972-232-2310
Practice Address - Fax:972-232-2310
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1110690225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1110690OtherEXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS