Provider Demographics
NPI:1265753495
Name:RUSSELL, BILLIE CHERIE (LCMTMMP)
Entity type:Individual
Prefix:MS
First Name:BILLIE
Middle Name:CHERIE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCMTMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 G RD
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-8613
Mailing Address - Country:US
Mailing Address - Phone:970-250-9365
Mailing Address - Fax:
Practice Address - Street 1:3735 G RD
Practice Address - Street 2:
Practice Address - City:PALISADE
Practice Address - State:CO
Practice Address - Zip Code:81526-8613
Practice Address - Country:US
Practice Address - Phone:970-250-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2423225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist