Provider Demographics
NPI:1336612563
Name:RUSSELL, WHITNEY LEE (MS, LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:LEE
Last Name:RUSSELL
Suffix:
Gender:F
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 1:201 PRESIDENTS CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-9049
Mailing Address - Country:US
Mailing Address - Phone:704-352-3332
Mailing Address - Fax:
Practice Address - Street 1:201 PRESIDENTS CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-9049
Practice Address - Country:US
Practice Address - Phone:704-352-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer