Doctor Name: | MS. ELIZABETH RUSSELL |
NPI Number: | 1023327590 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MA26845 |
Business Practice Address: | 120 Gateway Cir Unit 2 Saint Johns, FL - 322594082 |
Business Phone Number: | 9048249804 |
Business Fax Number: | |
Mailing Address: | 120 Gateway Cir, Unit 2 SAINT JOHNS |
State: | FL |
Postal Code: | 322594082 |
Phone Number: | 9048249804 |
Fax Number: | |
NPI Enumeration Date: | 10/01/2010 |
NPI Last Update Date: | 10/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA26845 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |