Individual
RUSSELL JOHN WAREHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6002 E 38TH ST, INDIANAPOLIS, IN 46226-5614
(317) 880-0280
Mailing address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5187
(317) 880-0280
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002776A
IN
Other
Enumeration date
05/28/2024
Last updated
05/28/2024
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