Individual
MRS. LORI ANN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2077 S INDEPENDENCE BLVD, VIRGINIA BEACH, VA 23453-4780
(757) 802-3665
Mailing address
3805 HAZEL CT, VIRGINIA BEACH, VA 23456-4934
(757) 395-0298
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306001051
VA
Other
Enumeration date
01/09/2017
Last updated
01/09/2017
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