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Individual

MS. LISA MICHELLE RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
1803 MICCOSUKEE COMMONS DR, STE 202, TALLAHASSEE, FL 32308
(850) 402-0200
(850) 402-0564
Mailing address
1950 N POINT BLVD, #1012, TALLAHASSEE, FL 32308
(850) 321-4482

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA36347
FL

Other

Enumeration date
11/07/2006
Last updated
07/08/2007
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