TRAVIS ODELL RUSSELL

FORT WORTH, TX
NPI1720568819
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: TX  2035186)
Enumeration Date2018-08-17
Last Update Date2018-08-17
Business Address
TRAVIS ODELL RUSSELL PTA
3600 ANGLE AVE
FORT WORTH, TX 76106-3559
Phone number: 817-624-6164
Mailing Address
TRAVIS ODELL RUSSELL PTA
419 S ELM ST
DENTON, TX 76201-6085
Phone number: 800-345-5603
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