Individual
CARLIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
575 8TH AVE FL 6, NEW YORK, NY 10018-3158
(631) 793-8970
Mailing address
43 BAYBERRY LN, MOUNT KISCO, NY 10549-4800
(914) 960-3074
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2113
CT
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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