Individual
RANDALL LOYD RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5958 SAINT BERNARD AVE, NEW ORLEANS, LA 70122-1324
(601) 206-9195
Mailing address
13 NORTHTOWN DR STE 110, JACKSON, MS 39211-3047
(601) 206-9195
(601) 957-8391
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05073
LA
Other
Enumeration date
12/30/2024
Last updated
12/31/2024
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