Individual
TINA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1023 WASHINGTON AVE, PORTLAND, ME 04103-2793
(207) 773-5778
(207) 773-5773
Mailing address
1023 WASHINGTON AVE, PORTLAND, ME 04103-2793
(207) 773-5778
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT4120
ME
Other
Enumeration date
04/03/2026
Last updated
04/03/2026
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