Individual
TRAVIS RICHARD RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1929 AIRPORT WAY, FAIRBANKS, AK 99701-4009
(907) 479-0036
Mailing address
PO BOX 543, ESTER, AK 99725-0543
(907) 750-0370
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
217106
AK
Other
Enumeration date
10/16/2024
Last updated
10/16/2024
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