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Derick Russell, MPT
NPI 1710907480 · on the registry since 2006 · sole proprietor
Practice
- Address
- 6326 West Roosevelt Rd
Oak Park, IL 60304 - Phone
- (708) 691-3562
- Fax
- (708) 660-9356
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 2251X0800X
2251X0800X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2007-07-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois