Individual
HEATHER JO ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
405 MONROE ST, PELLA, IA 50219-1189
(641) 628-6623
(641) 621-2223
Mailing address
405 MONROE ST, PELLA, IA 50219-1189
(641) 628-6623
(641) 621-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5139
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5139
IOWA LICENSE NUMBER
IA
Enumeration date
06/11/2009
Last updated
03/28/2017
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