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1053635268
SHAVONNE M RUSSELL
RICHMOND, VA
NPI
1053635268
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: VA 2306601563)
Enumeration Date
2010-03-16
Last Update Date
2010-03-16
Business Address
-- SHAVONNE M RUSSELL PTA
212 BILOXI RD
RICHMOND, VA 23223-3310
Phone number: 804-326-9245
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Mailing Address
-- SHAVONNE M RUSSELL PTA
212 BILOXI RD
RICHMOND, VA 23223-3310
Phone number: 804-326-9245
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