Individual
MRS. SARAH RUTH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
601 W LINCOLN AVE, CASEYVILLE, IL 62232-1306
(618) 344-9355
(618) 344-9356
Mailing address
270 CIRCLE DR, FAIRVIEW HEIGHTS, IL 62208-3302
(618) 398-1063
(618) 344-9356
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160003016
IL
Other
Enumeration date
06/11/2012
Last updated
06/11/2012
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