Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 028769-1 | NY |
NPI | 1003022021 |
---|---|
Provider Name | Ms. Katherine Anne Russ |
First Address | Cohoes, NY 12047-2217 |
Second Address | Cohoes, NY 12047-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |