Individual
GRACE JEWELL RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1821 HILLANDALE RD STE 25B, DURHAM, NC 27705-2671
(919) 660-6628
Mailing address
811 148TH CT NE, BRADENTON, FL 34212-5601
(816) 654-4708
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P22248
NC
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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