Individual
MICHELLE RENEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A
Contact information
Practice address
900 TUCK ST, LEBANON, PA 17042-7446
(717) 273-8595
Mailing address
217 REDWOOD LN, LEBANON, PA 17046-2039
(717) 279-7302
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE002061L
PA
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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