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MRS. THERESA DELORES RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
11577 RIO SECCO RD, PEYTON, CO 80831-4031
(757) 450-5773
Mailing address
11577 RIO SECCO RD, PEYTON, CO 80831-4031
(757) 450-5773

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
12203
CO

Other

Enumeration date
06/26/2012
Last updated
06/26/2012
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