| Doctor Name: | DR. STACY DALE RUSSELL |
| NPI Number: | 1275744328 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHYSICAL THERAPIST |
| License Number: | PT6114 |
| Business Practice Address: | 5050 S Florida Ave Lakeland, FL - 338132501 |
| Business Phone Number: | 8636883030 |
| Business Fax Number: | |
| Mailing Address: | 3695 Emerald Ln, MULBERRY |
| State: | FL |
| Postal Code: | 338607512 |
| Phone Number: | 9374165700 |
| Fax Number: | |
| NPI Enumeration Date: | 05/24/2007 |
| NPI Last Update Date: | 03/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT6114 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |