| NPI | 1013166453 |
|---|---|
| Former Name | STEPHANIE CELENE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 5586) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 5586) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2012-01-05 |