Individual
MRS. CATHERINE MARY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1067 PEACHTREE ST, LOUISVILLE, GA 30434-1558
(478) 625-7000
(478) 625-1175
Mailing address
1067 PEACHTREE ST, LOUISVILLE, GA 30434-1558
(478) 625-7000
(478) 625-1175
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA001765
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA001765
GEORGIA PHYSICAL THERAPY ASSISTANCE
GA
Enumeration date
12/10/2015
Last updated
12/10/2015
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