Individual
RANDY L. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
1315 S FOUNTAIN DR, OLATHE, KS 66061-7205
(913) 829-3133
Mailing address
21004 WEST 99TH ST, LENEXA, KS 66220
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103051
LICENSE#
KS
Enumeration date
08/13/2006
Last updated
07/08/2007
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