Russell Allen Fanning, PTA Valid NPI

Individual provider · Physical Therapy Assistant · Hydro, OK

NPI

1356556955

Type

Individual (Type 1)

Primary specialty

Physical Therapy Assistant

Specialty group

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy code

225200000X

License number

1498 (OK)

Sex

Male

Sole proprietor

Yes

Enumerated

2007-05-14

Last updated

2007-07-08