Individual
ALEXANDER GEOFFREY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS
Contact information
Practice address
60 MARKET ST STE 130, AVON, CT 06001-4282
(860) 703-8505
Mailing address
60 MARKET ST STE 130, AVON, CT 06001-4282
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14282
CT
225100000X
Physical Therapist
27263
MA
Other
Enumeration date
11/17/2023
Last updated
06/26/2024
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