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Individual

DERICK M RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MPT

Contact information

Practice address
6326 WEST ROOSEVELT RD, OAK PARK, IL 60304
(708) 691-3562
(708) 660-9356
Mailing address
1101 CIRCLE AVE, FOREST PARK, IL 60130-2326
(708) 691-3562
(708) 660-9356

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
IL

Other

Enumeration date
07/19/2006
Last updated
07/08/2007
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