Individual
MR. BRIAN SCOTT RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT COMT
Contact information
Practice address
6169 S JOG RD STE A11, LAKE WORTH, FL 33467-6586
(561) 432-0111
(561) 432-1075
Mailing address
PO BOX 290370, SUITE A-11, FT LAUDERDALE, FL 33329-0370
(954) 262-4346
(954) 262-2269
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT21672
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10769816
CAQH
FL
01
—
827472
GHI
FL
05
—
891440100
—
FL
Enumeration date
09/22/2006
Last updated
11/20/2020
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