Individual
PURNELL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
8507 OXON HILL RD STE 200-33, FORT WASHINGTON, MD 20744-4766
(202) 246-6601
Mailing address
2707 SHIPLEY TER SE APT 2, WASHINGTON, DC 20020-1823
(202) 246-6601
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019015297
VA
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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