Provider Demographics
NPI:1316266406
Name:RUSSELL, AMIE KATHRINE (PT, DPT, ATC)
Entity type:Individual
Prefix:MS
First Name:AMIE
Middle Name:KATHRINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 ARAPAHOE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9101
Mailing Address - Country:US
Mailing Address - Phone:970-214-1396
Mailing Address - Fax:
Practice Address - Street 1:107 W 29TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2200
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-635-3087
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist