Stacey Jo Russell, PTA

NPI #1033462114 in Riverside, Missouri

Provider Information

NPI Number: 1033462114
Entity Type: Individual
Name: Stacey Jo Russell, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Oct 26, 2012
Last Updated: May 25, 2020

Practice Location

Address: 4700 NW CLIFF VIEW DR
City: Riverside
State: Missouri
ZIP Code: 64150-1237
Phone: (816) 741-5105

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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