Anthony J Russo, PTA
Physical Therapy Assistant in Orange Park, FL. Individual provider (NPI-1).
NPI number1861990657
StatusActive
Last updated in NPPESJan 26, 2018
Details
- NPI
- 1861990657
- Entity type
- Individual (NPI-1)
- Name
- Anthony J Russo
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 26, 2018
- Last updated
- Jan 26, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | PTA28155 | FL | Yes |
Practice location
2300 Park Ave Ste 203Orange Park, FL 32073-5573
Phone 904-634-0640 · Fax 904-634-0203
Mailing address
6500 Bowden Rd Ste 103Jacksonville, FL 32216-8066
Phone 904-634-0640 · Fax 904-634-0203
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All 57 Physical Therapy Assistant providers in Orange Park · All 2,903 providers in Orange Park
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