Individual
MISS JESSICA JEAN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
219 S 4TH ST E, MISSOULA, MT 59801-2725
(406) 493-9507
Mailing address
219 S 4TH ST E, MISSOULA, MT 59801-2725
(406) 493-9507
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
670
MT
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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