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General NPI Number Information
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NPI Number | 1386018901
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Entity Type | Individual
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Provider Name | HOLLY RAEANN RUSS
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Gender | Female
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 907 S PALESTINE ST
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City | ATHENS
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State | TX
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Zip | 75751-3612
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Country | US
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Telephone | 903-675-0077
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Fax | 903-675-0078
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Provider Business Mailing Address
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Address Line | 907 S PALESTINE ST PO BOX 2028
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City | ATHENS
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State | TX
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Zip | 75751-3612
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Country | US
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Telephone | 903-675-0077
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Fax | 903-675-0078
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1215007
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License Number State | TX
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