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Individual
MR. RUSSELL WADE STEPHAN
Active
Individual
MR. RUSSELL WADE STEPHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSM MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT20296
FL
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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