Individual
MISS TAYLOR CAROLINE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS ATC LAT
Contact information
Practice address
2619 W FAIRVIEW AVE, BOISE, ID 83702-6722
(208) 706-9419
Mailing address
6547 S FAIRWIND PL, BOISE, ID 83709-5064
(713) 689-8442
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000023679
—
2255A2300X
Athletic Trainer
AT7609
TX
Other
Enumeration date
01/26/2023
Last updated
04/29/2026
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