Individual
MARK DUANE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, CSCS
Contact information
Practice address
3950 HOLLYWOOD RD STE 140, SAINT JOSEPH, MI 49085-9151
(269) 556-7150
Mailing address
4858 SADLER DR, WATERVLIET, MI 49098-8703
(269) 463-5859
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/21/2006
Last updated
07/08/2007
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