Provider Demographics
NPI:1851343453
Name:RUSSELL, JAMES SCOTT (MPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SCOTT
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MPT
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Mailing Address - Street 1:906 MEBANE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7951
Mailing Address - Country:US
Mailing Address - Phone:919-563-1825
Mailing Address - Fax:919-563-1833
Practice Address - Street 1:1713 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2915
Practice Address - Country:US
Practice Address - Phone:336-229-5531
Practice Address - Fax:336-229-5900
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851343453Medicaid
NC7212012Medicaid