Individual
MRS. GAIL LYN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
5224 N. 200TH ST, OBLONG, IL 62449
(618) 592-6353
(618) 546-2635
Mailing address
1000 N ALLEN ST, ROBINSON, IL 62454-1167
(618) 544-3131
(618) 546-2635
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
IL
Other
Enumeration date
06/04/2007
Last updated
07/08/2007
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