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1972716512
RUSSELL D BERRY
MANGUM, OK
NPI
1972716512
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: OK 812)
Enumeration Date
2007-05-08
Last Update Date
2010-03-29
Business Address
-- RUSSELL D BERRY LPTA
1 WICKERSHAM ST
MANGUM, OK 73554-9117
Phone number: 580-782-3353
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Mailing Address
-- RUSSELL D BERRY LPTA
PO BOX 104
GRANITE, OK 73547-0104
Phone number: 580-535-4581
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