Individual
MR. ANDREW PETER RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, SCAT
Contact information
Practice address
301 MEETING ST, CHARLESTON, SC 29424-1552
(757) 635-9512
Mailing address
1620 POINCARE BND, VIRGINIA BEACH, VA 23454-6926
(757) 635-9512
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2043
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/10/2016
Last updated
02/08/2018
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