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Individual
TRAVIS ODELL RUSSELL JR.
Active
Individual
TRAVIS ODELL RUSSELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2035186
TX
Other
Enumeration date
08/17/2018
Last updated
08/17/2018
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