Provider Demographics
NPI:1982387205
Name:RUSSELL, WILLIAM II (LMT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RUSSELL
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 S TOWNSEND AVE # 224
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5447
Mailing Address - Country:US
Mailing Address - Phone:970-312-5958
Mailing Address - Fax:
Practice Address - Street 1:22130 6850 RD # 67
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-6304
Practice Address - Country:US
Practice Address - Phone:970-312-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist