Individual
KIM RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2505 WASHINGTON BLVD, NORTH BELLMORE, NY 11710-2642
(516) 661-9877
Mailing address
2505 WASHINGTON BLVD, NORTH BELLMORE, NY 11710-2642
(516) 661-9877
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
015996
NY
Other
Enumeration date
09/08/2020
Last updated
09/08/2020
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