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General NPI Number Information
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NPI Number | 1336352962
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Entity Type | Individual
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Provider Name | BELINDA ELAINE RUSSO LMP
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 222 SUNSET DR. S.
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City | IONE
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State | WA
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Zip | 99139
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Country | US
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Telephone | 509-671-3552
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Fax | 509-442-3697
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Provider Business Mailing Address
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Address Line | PO BOX 944
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City | IONE
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State | WA
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Zip | 99139-0944
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Country | US
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Telephone | 509-671-3552
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Fax | 509-442-3697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00022692
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-08826
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License Number State | AZ
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