Individual
TYLER JOSEPH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2403 INDIANA AVE, FORT CAMPBELL, KY 42223-5314
(270) 412-5114
Mailing address
8901 WISCONSIN AVE, BETHESDA, MD 20889-0004
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
OS16674
FL
Other
Enumeration date
03/10/2018
Last updated
05/03/2023
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