Individual
ANTONINO ROBERTO RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1945 HILAND AVE, BURLEY, ID 83318-2714
(208) 647-0024
Mailing address
1411 FALLS AVE E STE 401, TWIN FALLS, ID 83301-3455
(208) 647-0024
(208) 647-0239
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7636
ID
Other
Enumeration date
11/18/2021
Last updated
11/18/2021
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