Provider Demographics
NPI:1033226188
Name:RUSS, MARY SUZANNE (RRT, CPFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SUZANNE
Last Name:RUSS
Suffix:
Gender:F
Credentials:RRT, CPFT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:SUZANNE
Other - Last Name:SAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT, CPFT
Mailing Address - Street 1:42 WOLF RD UNIT 823
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1938
Mailing Address - Country:US
Mailing Address - Phone:802-295-9363
Mailing Address - Fax:
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered