Provider Demographics
NPI:1699931980
Name:SADBERRY, RUSSELL ANDREW (ATC, LAT)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ANDREW
Last Name:SADBERRY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 HIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1107
Mailing Address - Country:US
Mailing Address - Phone:281-237-1922
Mailing Address - Fax:281-644-1700
Practice Address - Street 1:6331 HIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1107
Practice Address - Country:US
Practice Address - Phone:281-237-1922
Practice Address - Fax:281-644-1700
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT12252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer