Individual
COLLEEN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
805 AEROVISTA PL, SUITE 104, SAN LUIS OBISPO, CA 93401-7919
(805) 543-7771
(805) 543-7761
Mailing address
408 HIGUERA ST STE 200, SAN LUIS OBISPO, CA 93401-6135
(805) 788-0805
(805) 788-0845
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT32942
CA
Other
Enumeration date
11/21/2006
Last updated
08/15/2023
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