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Individual

MR. RUSSELL WADE LEES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
301 HARDING ST, CLAYTON, NM 88415-3321
(575) 374-5733
Mailing address
301 HARDING ST, CLAYTON, NM 88415-3321
(575) 374-5733

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2898
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
K5719
MEDICAID PROVIDER NUMBER
NM
Enumeration date
09/18/2008
Last updated
09/18/2008
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