Provider Demographics
NPI:1740340876
Name:RUSSO, DAVID SCOTT
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:RUSSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37026 US HIGHWAY 19 N
Mailing Address - Street 2:#330B
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1109
Mailing Address - Country:US
Mailing Address - Phone:727-938-1935
Mailing Address - Fax:727-937-7199
Practice Address - Street 1:37026 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1109
Practice Address - Country:US
Practice Address - Phone:727-938-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 211172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic