Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Miss. Taylor Caroline Russo, MSATCLAT

Individual provider Athletic Trainer · NPI 1972219582

Miss. Taylor Caroline Russo, MSATCLAT is an Athletic Trainer in Boise, Idaho. Practices as a sole proprietor. Licensed in Texas.

Licensed in
TX
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

2619 W Fairview Ave
Boise, ID 83702-6722
Phone: (208) 706-9419
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 2000023679
Athletic Trainer Taxonomy 2255A2300X · Licence AT7609 (TX)

Record details

NPI number1972219582
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSATCLAT
Sole proprietorYes
NPI enumeratedJanuary 26, 2023
Last updated in NPPESApril 29, 2026
Certification dateApril 29, 2026

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