Individual
ANTOINETTE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 BEALTON CT, FREDERICKSBURG, VA 22406-7284
(540) 310-7077
Mailing address
25 BEALTON CT, FREDERICKSBURG, VA 22406-7284
(540) 310-7077
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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