Individual
CARLY RUSSO WHITTAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2425 VICTORY AVE APT 264, DALLAS, TX 75219-7720
(610) 737-8046
Mailing address
2425 VICTORY AVE APT 264, DALLAS, TX 75219-7720
(610) 737-8046
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1315328
TX
Other
Enumeration date
02/08/2019
Last updated
02/03/2026
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