Individual
DR. JEFFREY ALAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, AT
Contact information
Practice address
SHAPE CLINIC, PUTNAM HALL 304, 96 E UNION ST, ATHENS, OH 45701
(740) 593-1829
(740) 593-0289
Mailing address
SCHOOL OF AHSW, GROVER E182, 53 RICHLAND AVE, ATHENS, OH 45701
(740) 593-4648
(740) 593-0289
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
000060285
—
2255A2300X
Athletic Trainer
Primary
AT003998
OH
Other
Enumeration date
11/22/2006
Last updated
01/31/2019
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