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General NPI Number Information
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NPI Number | 1992091763
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Entity Type | Individual
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Provider Name | LAUREN K RUSSELL PT
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Gender | Female
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 680 KINGSBOROUGH SQ STE B
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4988
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Country | US
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Telephone | 757-547-0434
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412307
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City | BOSTON
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State | MA
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Zip | 02241-2307
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Country | US
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Telephone | 914-294-4050
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Fax |
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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 | 23658
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 292097
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305213238
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License Number State | VA
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