Individual
HALLE TAMSEN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1 BEAR PL, WACO, TX 76798-0006
(415) 827-0802
Mailing address
PO BOX 1, SAN ANSELMO, CA 94979-0001
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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