Provider Demographics
NPI:1427305945
Name:RUSSELL, JOHN F (LMT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1835 NE MIAMI GARDENS DR
Mailing Address - Street 2:STE 195
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5035
Mailing Address - Country:US
Mailing Address - Phone:305-794-2340
Mailing Address - Fax:305-937-0110
Practice Address - Street 1:175 SW 7TH ST
Practice Address - Street 2:STE 1916
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2992
Practice Address - Country:US
Practice Address - Phone:305-794-2340
Practice Address - Fax:305-937-0110
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA18547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist