Individual
MR. RUSSELL DELA PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
555 E CHEVES ST, FLORENCE, SC 29506-2617
(843) 777-6700
Mailing address
601 IVANHOE DR, FLORENCE, SC 29505-3611
(843) 664-3083
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5011
SC
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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