Individual
KELSEY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1017 STINSON AVE, MATTOON, IL 61938-6044
(217) 232-1660
Mailing address
1017 STINSON AVE, MATTOON, IL 61938-6044
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005193
IL
Other
Enumeration date
12/15/2021
Last updated
12/22/2021
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