Provider Demographics
NPI:1699870279
Name:RUSSELL, ALISON N (PT)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:N
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 E PINNACLE PEAK RD
Mailing Address - Street 2:SUITE #138
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3630
Mailing Address - Country:US
Mailing Address - Phone:480-502-4324
Mailing Address - Fax:480-502-1397
Practice Address - Street 1:7430 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE #138
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3630
Practice Address - Country:US
Practice Address - Phone:480-502-4324
Practice Address - Fax:480-502-1397
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010222225100000X
AZ8080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8861822Medicare PIN
Z68419Medicare UPIN