Individual
EVELYN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
5750 SW 42ND ST, MIAMI, FL 33155-5310
(305) 790-2300
Mailing address
PO BOX 558075, MIAMI, FL 33255-8075
(305) 790-2300
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA40587
FL
Other
Enumeration date
11/14/2006
Last updated
09/09/2016
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