Individual
JORDAN CARVER RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17323 INTERSTATE 35 N STE 107, SCHERTZ, TX 78154-1278
(210) 659-4333
Mailing address
9003 QUAKER RDG, SELMA, TX 78154-1330
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1362087
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1362087
TEXAS BOARD OF PHYSICAL THERAPY
TX
Enumeration date
10/10/2022
Last updated
10/10/2022
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