Individual
MICHELLE JEAN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5538 N SHASTA DR, GLENDALE, WI 53209-4925
(920) 540-8626
Mailing address
5538 N SHASTA DR, GLENDALE, WI 53209-4925
(920) 540-8626
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11860-24
WI
Other
Enumeration date
11/10/2011
Last updated
03/13/2014
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