Organization
BRETT RUSSELL PHYSICAL THERAPY AND FITNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT LEE RUSSELL PT,ATC,LMT (PRESIDENT)
(864) 363-8119
Entity
Organization
Contact information
Practice address
600 N HIGHWAY 25, TRAVELERS REST, SC 29690-9388
(864) 834-4995
(864) 834-4551
Mailing address
600 N HIGHWAY 25, TRAVELERS REST, SC 29690-9388
(864) 834-4995
(864) 834-4551
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2005
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9388
MEDICARE PTAN
SC
Enumeration date
10/16/2006
Last updated
10/13/2015
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