Individual
JENNIFER LYNN RUSSELL TOSTENRUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
8717
CO
225100000X
Physical Therapist
Primary
PT 60671
OR
225100000X
Physical Therapist
PT00009657
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487638250
—
WA
05
—
500679013
—
OR
05
—
8418055
—
WA
01
—
P00393824
RR MEDICARE
WA
Enumeration date
12/05/2005
Last updated
02/13/2015
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