DERICK M RUSSELL

OAK PARK, IL
NPI1710907480
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2251X0800X Physical Therapist, Orthopedic
(Licence: IL  070-013337)
Enumeration Date2006-07-19
Last Update Date2007-07-08
Business Address
-- DERICK M RUSSELL MPT
6326 WEST ROOSEVELT RD
OAK PARK, IL 60304
Phone number: 708-691-3562
Mailing Address
-- DERICK M RUSSELL MPT
1101 CIRCLE AVE
FOREST PARK, IL 60130-2326
Phone number: 708-691-3562
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