Individual
JACQUELINE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 SEMINARY AVE, AUBURNDALE, MA 02466-2650
(617) 633-7100
Mailing address
36 FRANCIS ST, BELMONT, MA 02478-2220
(617) 874-0765
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9508
MA
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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