Penny Russ, PTA

NPI #1134278062 in Streator, Illinois

Provider Information

NPI Number: 1134278062
Entity Type: Individual
Name: Penny Russ, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Jan 9, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 205 S PARK ST
City: Streator
State: Illinois
ZIP Code: 61364-4448
Phone: (815) 673-1770

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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