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1013487271
NICHOLAS RUSSELL
HOLLAND, MI
NPI
1013487271
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: MI 5501018629)
Enumeration Date
2018-11-30
Last Update Date
2018-11-30
Business Address
NICHOLAS RUSSELL
602 MICHIGAN AVE
HOLLAND, MI 49423-4918
Phone number: 616-392-5141
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Mailing Address
NICHOLAS RUSSELL
263 N DIVISION AVE
HOLLAND, MI 49424-6459
Phone number:
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