Individual
MISS KATHLEEN MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4235 SECOR RD, TOLEDO, OH 43623-4231
(419) 479-5960
Mailing address
4235 SECOR RD, TOLEDO, OH 43623-4231
(419) 479-5960
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-9942
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2375111
—
OH
Enumeration date
11/09/2005
Last updated
05/09/2016
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