Individual
MR. MATTHEW THOMAS RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3535 HILL BLVD, SUITE P, YORKTOWN HEIGHTS, NY 10598-1293
(914) 962-2728
(914) 962-1729
Mailing address
PO BOX 673, GOSHEN, NY 10924-0673
(845) 294-5065
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001809-1
NY
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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