Individual
JESSIKA LYNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1199 HAYES FOREST DR, WINSTON SALEM, NC 27106-3377
(336) 337-5113
Mailing address
9923 REYNOLDA RD, TOBACCOVILLE, NC 27050-9729
(336) 337-5113
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A5651
NC
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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