Individual
MRS. LANITA KAYE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT,DPT
Contact information
Practice address
400 S MAIN ST STE 500, SEARCY, AR 72143-6848
(501) 278-9904
(501) 278-9906
Mailing address
400 S MAIN ST STE 500, SUITE 500, SEARCY, AR 72143-6848
(501) 278-9904
(501) 278-9906
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT,DPT 3303
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183978721
—
AR
Enumeration date
10/07/2010
Last updated
11/09/2010
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