Individual
BETZY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1524 JASPER ST, MEDFORD, OR 97501-4042
(541) 951-6051
Mailing address
1524 JASPER ST, MEDFORD, OR 97501-4042
(541) 951-6051
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13399
OR
Other
Enumeration date
03/22/2017
Last updated
03/22/2017
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