Individual
RUSSELL PENNINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
146 VILLAGE DRIVE, COTTAGE GROVE, OR 97424-9544
(541) 228-4086
Mailing address
146 VILLAGE DR, COTTAGE GROVE, OR 97424-9544
(541) 228-4086
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09348
OR
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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