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1124191226
RUSSELL WADE STEPHAN
FORT MYERS, FL
NPI
1124191226
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: FL PT20296)
Enumeration Date
2006-11-16
Last Update Date
2007-07-08
Business Address
Mr. RUSSELL WADE STEPHAN MSM MPT
9371 CYPRESS LAKE DR SUITE 20
FORT MYERS, FL 33919-4939
Phone number: 239-415-2595
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Mailing Address
Mr. RUSSELL WADE STEPHAN MSM MPT
9371 CYPRESS LAKE DR SUITE 20
FORT MYERS, FL 33919-4939
Phone number: 239-415-2595
Copy
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