Charlene Russell, LMT
Individual provider Active NPI Mechanotherapist · Vancleave, MS
NPI 1013303296 · NPPES record last updated Apr 14, 2015
Key facts
- NPI
- 1013303296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mechanotherapist 172M00000X
- License
- 35 (MS)
- Practice address
- 12603 Highway 57
Vancleave, MS 39565-7420 - Phone
- (228) 283-5083
- NPI assigned
- Apr 14, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35 | MS | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Massage Connexion, LLC | Mechanotherapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 35 | MS | Yes |
| Massage Therapist | 225700000X | 35 | MS |
Addresses
Primary practice location
12603 Highway 57
Vancleave, MS 39565-7420
Mailing address
PO Box 5667
Vancleave, MS 39565-5667
Phone (228) 283-5083
Other providers in Vancleave, MS
- Prism Psych, PLLC
- Melissa Ann Ranson
- Karen Petra Reynolds
- Katherine Sloop Roberts
- Jayme Robinson
- Kimberly Nicole Sanders
- Nathaniel Lee Sexton
- Kathleen Suzanne Seymour-Swetman
- Pooja Sharma
- Kaila Sue Shoemake
All providers in Vancleave, MS · Mechanotherapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.