Individual
KAREN MICHELE VARISCO-RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-7183
Mailing address
136 MAPLE HILL DR, NEWNAN, GA 30265-5580
(770) 253-5443
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA001748
GA
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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