Individual
MR. RUSSELL ALLEN FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
800 N. ARAPAHO, HYDRO, OK 73048
(405) 663-2335
Mailing address
421 N DANIEL ST, WEATHERFORD, OK 73096-4415
(580) 603-1744
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1498
OK
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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