Provider Demographics
NPI:1326358235
Name:RUSSELL, KATHERINE (CMT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1291
Mailing Address - Country:US
Mailing Address - Phone:248-828-0088
Mailing Address - Fax:
Practice Address - Street 1:6846 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1291
Practice Address - Country:US
Practice Address - Phone:248-828-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist