Individual
CHARLOTTE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2 LAUREL AVE, WELLESLEY, MA 02481-7523
(781) 237-5585
Mailing address
2 LAUREL AVE, WELLESLEY, MA 02481-7523
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
25557
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04-3527497
—
MA
Enumeration date
08/04/2021
Last updated
08/04/2021
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