Doctor Name: | TIMOTHY LYNN RUSSELL |
NPI Number: | 1487863403 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | MT173 |
Business Practice Address: | 1100 E 3rd St Suite G-100 Chattanooga, TN - 374032201 |
Business Phone Number: | 4236431965 |
Business Fax Number: | 4236432030 |
Mailing Address: | 1100 E 3rd St, Suite G-100 CHATTANOOGA |
State: | TN |
Postal Code: | 374032201 |
Phone Number: | 4236431965 |
Fax Number: | 4236432030 |
NPI Enumeration Date: | 05/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT173 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
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. |