Provider Demographics
NPI:1619414935
Name:RUSSELL, BRITTANY (MAT, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 AHLENA WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-9568
Mailing Address - Country:US
Mailing Address - Phone:502-649-3200
Mailing Address - Fax:
Practice Address - Street 1:703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-8695
Practice Address - Country:US
Practice Address - Phone:270-699-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT10742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer