Provider Demographics
NPI:1013223528
Name:RUSSO, CHRISTINA MARIE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8380 WARREN PKWY
Mailing Address - Street 2:SUITE 502
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4198
Mailing Address - Country:US
Mailing Address - Phone:214-618-8055
Mailing Address - Fax:214-618-8075
Practice Address - Street 1:8380 WARREN PKWY
Practice Address - Street 2:SUITE 502
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4198
Practice Address - Country:US
Practice Address - Phone:214-618-8055
Practice Address - Fax:214-618-8075
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1198529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist