Individual
CAITLIN HOPE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1709 CHAMBERS DR APT 24, MATTHEWS, NC 28105-4781
(704) 614-4540
Mailing address
1709 CHAMBERS DR APT 24, MATTHEWS, NC 28105-4781
(704) 614-4540
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-4266
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
22
NC
Enumeration date
04/09/2020
Last updated
04/09/2020
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