Individual
ELIZABETH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
21003 IH 35, KYLE, TX 78640-4745
(512) 268-2141
Mailing address
21003 IH 35, KYLE, TX 78640-4745
(512) 268-2141
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT3164
TX
Other
Enumeration date
04/21/2014
Last updated
04/21/2014
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