Individual
MICHELE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7655 TUNNEL HILL RD, GOREVILLE, IL 62939-2820
(618) 926-2456
Mailing address
7655 TUNNEL HILL RD, GOREVILLE, IL 62939-2820
(618) 926-2456
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227014287
IL
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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