Individual
DALTON LEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8649 HIGHWAY 165 N STE 5, MONROE, LA 71203-8965
(318) 235-9326
(318) 267-0131
Mailing address
324 PULLTIGHT RD, OAK GROVE, LA 71263-9187
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11681
LA
Other
Enumeration date
02/02/2024
Last updated
02/02/2024
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