Basic Information
| Provider Information | |||||||||
| NPI: | 1144282344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUFFSTETLER | ||||||||
| FirstName: | RUSS | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1004 | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383581004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316132214 | ||||||||
| FaxNumber: | 7316132215 | ||||||||
| Practice Location | |||||||||
| Address1: | 6070 S 1ST ST STE D | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383583186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316132214 | ||||||||
| FaxNumber: | 7316132215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 07/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7118 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.