# BRETT RUSSELL PHYSICAL THERAPY AND FITNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083704225
- **Authorized official:** BRETT LEE RUSSELL PT,ATC,LMT (PRESIDENT)
- **Authorized official phone:** (864) 363-8119

## Contact information

- **Practice address:** 600 N HIGHWAY 25, TRAVELERS REST, SC 29690-9388
- **Practice address phone:** (864) 834-4995
- **Practice address fax:** (864) 834-4551
- **Mailing address:** 600 N HIGHWAY 25, TRAVELERS REST, SC 29690-9388
- **Mailing address phone:** (864) 834-4995
- **Mailing address fax:** (864) 834-4551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 2005 | SC | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 10/13/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 9388 | MEDICARE PTAN | SC |