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1548817273
NICHOLAS ANDREW RUSSELL
SHREVEPORT, LA
NPI
1548817273
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: LA 10340)
Enumeration Date
2019-08-19
Last Update Date
2019-08-19
Business Address
NICHOLAS ANDREW RUSSELL DPT
1450 CLAIBORNE AVE
SHREVEPORT, LA 71103-4204
Phone number: 318-813-2970
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Mailing Address
NICHOLAS ANDREW RUSSELL DPT
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-813-2962
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