Individual
MAREDITH ANNE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
955 RIBAUT RD, BEAUFORT, SC 29902
(843) 522-5900
Mailing address
955 RIBAUT RD, BEAUFORT, SC 29902-5441
(843) 522-5900
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
8612
SC
Other
Enumeration date
09/19/2017
Last updated
07/21/2022
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