Individual
NICHOLAS RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16811 N LITCHFIELD RD STE 101, SURPRISE, AZ 85374-7062
(602) 313-4045
(623) 322-0664
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT36549
FL
225100000X
Physical Therapist
Primary
—
AZ
Other
Enumeration date
11/23/2020
Last updated
05/10/2024
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