Provider Demographics
NPI:1932551181
Name:RUSSOMANNO, MARIA E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:RUSSOMANNO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:ELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1777 W SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2687
Mailing Address - Country:US
Mailing Address - Phone:502-884-4292
Mailing Address - Fax:520-867-6681
Practice Address - Street 1:1605 E RIVER RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5973
Practice Address - Country:US
Practice Address - Phone:520-884-4292
Practice Address - Fax:520-867-6681
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210207225100000X
AZLPT-012380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist