Organization
CROCKETT RANCH THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY RUSSELL RN (SOLE PROPRIETOR)
(928) 853-9843
Entity
Organization
Contact information
Practice address
11705 N US HIGHWAY 89, FLAGSTAFF, AZ 86004-5327
(928) 853-9843
Mailing address
11705 N US HIGHWAY 89, FLAGSTAFF, AZ 86004-5327
(928) 853-9843
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
06/04/2014
Last updated
06/04/2014
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