Provider Demographics
NPI:1255703732
Name:MUIR, RUSSELL (EDD, ATC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:MUIR
Suffix:
Gender:M
Credentials:EDD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 N YALE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2739
Mailing Address - Country:US
Mailing Address - Phone:562-212-3079
Mailing Address - Fax:
Practice Address - Street 1:3600 WORKMAN MILL RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601
Practice Address - Country:US
Practice Address - Phone:562-463-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer