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Individual
MR. RUSSELL TAVERAS
Active
Individual
MR. RUSSELL TAVERAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0270991
NY
Other
Enumeration date
08/20/2006
Last updated
03/07/2012
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