Provider Demographics
NPI:1225698210
Name:RUSSELL, ALEX W (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:W
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MAY LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-4804
Mailing Address - Country:US
Mailing Address - Phone:505-917-3911
Mailing Address - Fax:
Practice Address - Street 1:9 MAY LN
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-4804
Practice Address - Country:US
Practice Address - Phone:505-917-3911
Practice Address - Fax:479-250-0379
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1324750225100000X
NMPT5503225100000X
ARPT5415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist