Individual
BRADLEY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
416 E VERONA AVE, VERONA, WI 53593-1227
(608) 848-6628
(608) 848-6629
Mailing address
416 E VERONA AVE, VERONA, WI 53593-1227
(608) 848-6628
(608) 848-6629
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14739-24
WI
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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