Provider Demographics
NPI:1851273361
Name:RUSSELL-FRY, WHITNEY MEREDITH (DPT)
Entity type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:MEREDITH
Last Name:RUSSELL-FRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:WHITNEY
Other - Middle Name:MEREDITH
Other - Last Name:BRECKENRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:862 TOPSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-5016
Mailing Address - Country:US
Mailing Address - Phone:843-697-9823
Mailing Address - Fax:
Practice Address - Street 1:862 TOPSFIELD DR
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-5016
Practice Address - Country:US
Practice Address - Phone:843-697-9823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017036733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist