Provider Demographics
NPI:1831424803
Name:RUSSELL, KATHY JOSEPHINE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JOSEPHINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 QUAIL DR S
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1076
Mailing Address - Country:US
Mailing Address - Phone:610-415-0176
Mailing Address - Fax:
Practice Address - Street 1:8 QUAIL DR S
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1076
Practice Address - Country:US
Practice Address - Phone:610-415-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003686L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist