Individual
MICHELE RENAE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
4830 HIGHWAY 260 STE 105, LAKESIDE, AZ 85929-5851
(928) 532-1221
Mailing address
PO BOX 658, LAKESIDE, AZ 85929-0658
(928) 242-0821
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
31790
AZ
Other
Enumeration date
06/16/2021
Last updated
04/21/2022
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