Individual
MR. RUSSELL ALLAN REAVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
910 10TH ST SE, QUINCY, WA 98810
(509) 797-3531
Mailing address
908 10TH AVE SW, QUINCY, WA 98848-1376
(509) 797-3531
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
60065774
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60065774
—
WA
Enumeration date
03/23/2021
Last updated
03/23/2021
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