Individual
CONNIE JO RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
34921 US 19 N STE 250, PALM HARBOR, FL 34684-1969
(727) 992-1696
Mailing address
PO BOX 1252, TARPON SPRINGS, FL 34688-1252
(727) 992-1696
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25841
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1876171
MASSAGE THERAPIST
FL
Enumeration date
11/04/2021
Last updated
11/13/2024
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