Individual
BROOKE ALLYN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1408 GREENWAY CT, SANFORD, NC 27330-6953
(919) 708-7220
Mailing address
1408 GREENWAY CT, SANFORD, NC 27330-6953
(919) 708-7220
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6286
NC
Other
Enumeration date
10/24/2017
Last updated
10/24/2017
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