Individual
ANGELINA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 W PEARL AVE, JACKSON, WY 83001-8657
(307) 734-9129
Mailing address
230 E BROADWAY APT 609, SALT LAKE CITY, UT 84111-2441
(561) 951-0121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2435
WY
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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