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Individual

DR. JASON RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
3980 SOUTH JACKSON DR, INDEPENDENCE, MO 64057
(816) 795-1433
Mailing address
703 NW PAR DR, GRAIN VALLEY, MO 64029-7347
(816) 438-9385

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2012027765
MO

Other

Enumeration date
05/01/2014
Last updated
05/01/2014
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