Organization
AMPIC REHAB, PLLC
Active
Other names
Ampic Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK BRENNAN RUSSO PT, DPT (OWNER/PHYSICAL THERAPIST)
(214) 733-7869
Entity
Organization
Contact information
Practice address
7704 SAN JACINTO PL, SUITE 200, PLANO, TX 75024-3202
(214) 733-7869
Mailing address
4510 DRUID LN, #111, DALLAS, TX 75205-4717
(214) 733-7869
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1178901
TX
225100000X
Physical Therapist
1198529
TX
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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