Individual
MISTY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
420 GREEN ST, PERRYSVILLE, IN 47974
(812) 201-7403
Mailing address
420 GREEN ST, PERRYSVILLE, IN 47974
(812) 201-7403
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.021427
IL
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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