Individual
MS. ELIZABETH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 GATEWAY CIR, UNIT 2, SAINT JOHNS, FL 32259-4082
(904) 824-9804
Mailing address
120 GATEWAY CIR, UNIT 2, SAINT JOHNS, FL 32259-4082
(904) 824-9804
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA26845
FL
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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