Individual
DANIELLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1010 ROBERT BUSH DRIVE WEST, SOUTH BEND, WA 98586
(360) 875-5543
Mailing address
37 PENNY LN, RAYMOND, WA 98577-9002
(360) 589-8354
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P160280156
WA
Other
Enumeration date
07/26/2022
Last updated
07/26/2022
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