Individual
RUSSELL SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1225 TRIUMPH CT, LAS VEGAS, NV 89117-7122
(248) 930-2554
Mailing address
8777 W MAULE AVE UNIT 2012, LAS VEGAS, NV 89148-4874
(631) 404-2829
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-1331
NV
Other
Enumeration date
01/25/2023
Last updated
01/25/2023
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