Provider Demographics
NPI:1902591548
Name:RUSSELL, LINNEA (DPT)
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 N 200 E STE 2
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1944
Mailing Address - Country:US
Mailing Address - Phone:435-753-1844
Mailing Address - Fax:435-753-2986
Practice Address - Street 1:1655 N 200 E STE 2
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1944
Practice Address - Country:US
Practice Address - Phone:435-753-1844
Practice Address - Fax:435-753-2986
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131857552401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist