Individual
ERICKA N RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
511 N MONTE VISTA ST, ADA, OK 74820-4611
(580) 436-3633
Mailing address
511 N MONTE VISTA ST, ADA, OK 74820-4611
(580) 436-3633
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2580
OK
Other
Enumeration date
03/10/2016
Last updated
03/10/2016
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