Individual
MR. RUSSELL CHRISCHILLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA-BA
Contact information
Practice address
1525 W 5TH ST, STORM LAKE, IA 50588-3027
(712) 213-8674
Mailing address
503 LAKEVIEW LN, LAKESIDE, IA 50588-7653
(712) 732-1645
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0618
IA
Other
Enumeration date
05/24/2012
Last updated
05/24/2012
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