Individual
JESSICA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
4327 NAKOMA RD, MADISON, WI 53711-3757
(608) 640-4100
Mailing address
894 LEEWARD LN, OREGON, WI 53575-3455
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15461-24
WI
Other
Enumeration date
02/21/2025
Last updated
02/21/2025
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