Individual
ANGELA LANDON RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
9830 HARBOR MASTER BLVD, OCEAN CITY, MD 21842-9381
(410) 713-2216
Mailing address
9830 HARBOR MASTER BLVD, OCEAN CITY, MD 21842-9381
(410) 713-2216
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
18674
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
216538
MEDICARE
MD
05
—
435138000
—
MD
Enumeration date
04/20/2010
Last updated
01/14/2015
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