Individual
JOEL RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AT, ATC
Contact information
Practice address
2350 MIAMI VALLEY DR, CENTERVILLE, OH 45459-4778
(937) 438-7755
Mailing address
1917 PENNSYLVANIA DR, XENIA, OH 45385-4537
(937) 272-9204
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.004379
OH
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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