Provider Demographics
NPI:1003022021
Name:RUSS, KATHERINE ANNE (DPT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANNE
Last Name:RUSS
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:421 COLUMBIA ST
Mailing Address - Street 2:EDDY COHOES REHABILITATION CENTER
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2217
Mailing Address - Country:US
Mailing Address - Phone:518-238-4012
Mailing Address - Fax:518-238-4052
Practice Address - Street 1:421 COLUMBIA ST
Practice Address - Street 2:EDDY COHOES REHABILITATION CENTER
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2217
Practice Address - Country:US
Practice Address - Phone:518-238-4012
Practice Address - Fax:518-238-4052
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY028769-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist