Individual
DR. ELLERY T. RUSSIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1959 NE PACIFIC ST, BOX 356490, SEATTLE, WA 98195-0001
(206) 598-4830
(206) 598-4897
Mailing address
PO BOX 24366, SEATTLE, WA 98124-0366
(206) 598-0502
(206) 598-0516
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00009931
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69744U
REGENCE BLUE SHIELD
WA
Enumeration date
12/29/2006
Last updated
09/05/2007
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