Provider Demographics
NPI:1285886309
Name:RUSSELL, ERIN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARIE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:CLAYCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:360 MASSANUTTEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22824-3026
Mailing Address - Country:US
Mailing Address - Phone:540-984-3593
Mailing Address - Fax:
Practice Address - Street 1:360 MASSANUTTEN DRIVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:VA
Practice Address - Zip Code:22824-3026
Practice Address - Country:US
Practice Address - Phone:540-984-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist