Provider Demographics
NPI:1780967166
Name:RUSSELL, JODI LYNN (MS, ATC)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:RUSSELL
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Gender:F
Credentials:MS, ATC
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Mailing Address - Street 1:1350 BROADCASTING RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3229
Mailing Address - Country:US
Mailing Address - Phone:610-685-9600
Mailing Address - Fax:610-685-6700
Practice Address - Street 1:1350 BROADCASTING RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3229
Practice Address - Country:US
Practice Address - Phone:610-685-9600
Practice Address - Fax:610-685-6700
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PART0044162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer