Provider Demographics
NPI:1669450235
Name:RUSSELL, CHRISTOPHER P (DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:P
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47149 BUSE RD
Mailing Address - Street 2:BLDG 1370
Mailing Address - City:PATUXENT RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20670-1540
Mailing Address - Country:US
Mailing Address - Phone:301-342-9503
Mailing Address - Fax:301-342-4718
Practice Address - Street 1:47149 BUSE RD
Practice Address - Street 2:BLDG 1370
Practice Address - City:PATUXENT RIVER
Practice Address - State:MD
Practice Address - Zip Code:20670-1540
Practice Address - Country:US
Practice Address - Phone:301-342-9503
Practice Address - Fax:301-342-4718
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN