Basic Information
| Provider Information | |||||||||
| NPI: | 1134341456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANKEY | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | LOGANVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539439645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087272016 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2000 N DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539591049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085246487 | ||||||||
| FaxNumber: | 6085246196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225200000X | 94-019 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.