# FRANK I RUSSO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Russo Rehabilitation Medicine LTD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639140833
- **Authorized official:** MS. CARRIE LYN CHIARAVALLE (DIRECTOR)
- **Authorized official phone:** (309) 689-6049

## Contact information

- **Practice address:** 5401 N KNOXVILLE AVE, SUITE 218, PEORIA, IL 61614-5098
- **Practice address phone:** (309) 693-2244
- **Practice address fax:** (309) 693-7606
- **Mailing address:** 5401 N KNOXVILLE AVE, SUITE 209, PEORIA, IL 61614-5098
- **Mailing address phone:** (309) 693-2244
- **Mailing address fax:** (309) 693-7606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/27/2006
- **Last updated:** 08/22/2020