Individual
KRISTIN B RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070014170
IL
225100000X
Physical Therapist
Primary
10259024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11454657
CAQH
—
05
—
40441700
—
WI
Enumeration date
07/03/2006
Last updated
07/27/2020
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