| NPI | 1487638250 |
|---|---|
| Former Name | JENNIFER LYNN RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR PT 60671) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8717) |
| 225100000X Physical Therapist (Licence: WA PT00009657) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2015-02-13 |