Individual
ELIZABETH DIANE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
5407 UNION SQ, BENTON, AR 72019-6898
(205) 394-0120
Mailing address
5407 UNION SQ, BENTON, AR 72019-6898
(205) 394-0120
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3111
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184220721
—
AR
Enumeration date
03/26/2007
Last updated
11/29/2010
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