Individual
KAYMEN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3425 N LIBERTY ST, CANTON, MS 39046-3761
(601) 691-5132
Mailing address
3425 N LIBERTY ST, CANTON, MS 39046-3761
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA7166
MS
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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