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1225108046
LISA A RUSSELL
ATHENS, TN
NPI
1225108046
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: TN PTA0000003858)
Enumeration Date
2006-11-09
Last Update Date
2007-07-08
Business Address
-- LISA A RUSSELL PTA
1204 FRYE ST
ATHENS, TN 37303
Phone number: 423-745-0434
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Mailing Address
-- LISA A RUSSELL PTA
204 ARRANTS AVE
DECATUR, TN 37322-7971
Phone number: 423-745-0434
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