IndividualActive
Derick Russell, MPT
NPI 1710907480 · Orthopedic Physical Therapist · Oak Park, IL
Provider details
- NPI number
- 1710907480
- Entity type
- Individual
- Primary specialty
- Orthopedic Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- MPT
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
6326 West Roosevelt Rd
Oak Park, IL 60304
Phone: (708) 691-3562
Fax: (708) 660-9356
Approximate (ZIP-level) locationGet directions
Mailing address
1101 Circle Ave
Forest Park, IL 60130-2326
Registry dates
- Enumerated
- 2006-07-19
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.