Provider Demographics
NPI:1467038521
Name:RUSSELL, JULIA MARIE (CMT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
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 1:91B WEST ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1926
Mailing Address - Country:US
Mailing Address - Phone:802-343-7574
Mailing Address - Fax:
Practice Address - Street 1:239 S UNION ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4886
Practice Address - Country:US
Practice Address - Phone:802-343-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT164.0000286225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT164.0000286OtherMASSAGE THERAPIST, BODYWORKER, OR TOUCH PROFESSIONAL LICENSE