Provider Demographics
NPI:1659363349
Name:RUSSELL, NANCY J (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:J
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:ORMSBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:10004 204TH AVE E
Practice Address - Street 2:STE 3100
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6539
Practice Address - Country:US
Practice Address - Phone:253-863-7510
Practice Address - Fax:253-863-5970
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5872RUOtherREGENCE BS
WA157404OtherDEPT. OF LABOR AND INDUST
WA650022436OtherR/R MED PC
WA650022435OtherR/R MED KC
WA8334070Medicaid
WA8936357OtherCRIME VICTIMS
WA650022436OtherR/R MED PC
WA8936357OtherCRIME VICTIMS