Provider Demographics
NPI:1710060660
Name:FOX, RUSSELL B (PT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:B
Last Name:FOX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RUSSELL
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 WAYLAND SMITH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-437-8200
Mailing Address - Fax:724-437-6673
Practice Address - Street 1:150 WAYLAND SMITH DR
Practice Address - Street 2:SUITE A
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-437-8200
Practice Address - Fax:724-437-6673
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist