Individual
JULIE M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPTA
Contact information
Practice address
4801 10TH ST, GREAT BEND, KS 67530-3252
(620) 792-7868
Mailing address
2912 R RD, HAVILAND, KS 67059-4718
(620) 770-0490
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-01047
KS
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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