MEDICARE: STEPHEN CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT104454	TX

General Provider Information

NPI Number	:	1457188328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN CAMPBELL

Provider Business Mailing Address
First Line	:	2530 ASHLOCK DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-4787
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 ASHLOCK DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-4787
Country	:	US
Telephone Number	:	971-533-2046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	06/11/2026

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Directions to “ STEPHEN CAMPBELL ” Practice Location

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