NPI 1013303296

Charlene Russell, LMT

Practitioner Mechanotherapist Vancleave, MS

Practice location

Address: 12603 Highway 57, Vancleave, MS 39565-7420
Phone: (228) 283-5083
Mailing address: PO Box 5667, Vancleave, MS 39565-5667

Registered specialties (2)

Mechanotherapist Primary

Other Service Providers Taxonomy 172M00000X Licence 35 (MS)

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Massage Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 35 (MS)

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Registry record

NPI: 1013303296
Entity type: Individual
Sex (as registered): Female
NPI issued: 14 Apr 2015
Record last updated: 14 Apr 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.