Individual
ABBY GRACE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
107 SUMMER LN, WEST MONROE, LA 71291-3501
(318) 396-1969
(318) 396-1970
Mailing address
PO BOX 1377, WEST MONROE, LA 71294-1377
(318) 396-1969
(318) 396-1970
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08632
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8632
PT LICENSE
LA
Enumeration date
08/26/2013
Last updated
09/11/2020
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