Provider Demographics
NPI:1922451616
Name:RUSSELL, DONALD E IV (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:E
Last Name:RUSSELL
Suffix:IV
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 TALL OAK DR
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-2347
Mailing Address - Country:US
Mailing Address - Phone:207-290-1190
Mailing Address - Fax:
Practice Address - Street 1:650 S BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-9636
Practice Address - Country:US
Practice Address - Phone:717-432-8691
Practice Address - Fax:717-432-7393
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0058412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer