Individual
KRISTA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5121
Mailing address
603 CAT TAIL LN, MANCHESTER, CT 06042-7104
(740) 374-2107
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005597
CT
225100000X
Physical Therapist
010164
OH
Other
Enumeration date
06/29/2007
Last updated
11/21/2012
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