Individual
DUVAL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
7400 RED BUG LAKE RD FL 32765, OVIEDO, FL 32765-7154
(407) 971-2774
Mailing address
7400 RED BUG LAKE RD FL 32765, OVIEDO, FL 32765-7154
(407) 971-2774
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA26037
FL
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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