Individual
MR. DONALD E. RUSSELL IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
650 S BALTIMORE ST, DILLSBURG, PA 17019-9636
(717) 432-8691
(717) 432-7393
Mailing address
226 TALL OAK DR, NEW CUMBERLAND, PA 17070-2347
(207) 290-1190
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT005841
PA
Other
Enumeration date
07/18/2016
Last updated
02/29/2020
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