Doctor Name: | MR. GYLES DONALD RUSSELL |
NPI Number: | 1205990827 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | PT 157 |
Business Practice Address: | 800 Oak Ridge Tpke Suite C 102 Oak Ridge, TN - 378306957 |
Business Phone Number: | 8654837790 |
Business Fax Number: | 8654837791 |
Mailing Address: | 116 Dartmouth Cir, OAK RIDGE |
State: | TN |
Postal Code: | 378307703 |
Phone Number: | 8654836850 |
Fax Number: | 8654837791 |
NPI Enumeration Date: | 12/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | PT 157 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |