Individual
NICOLE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
38 MONTVALE AVE STE 330, STONEHAM, MA 02180-2450
(978) 886-5441
Mailing address
163 WEST ST APT 3, MALDEN, MA 02148-6532
(978) 886-5441
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2452
MA
Other
Enumeration date
08/03/2009
Last updated
08/03/2009
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