MEDICARE: DR. SUZANN K. CAMPBELL P.T.

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	2251P0200X	Pediatric Physical Therapist	070.005147	IL
2	2251P0200X	Pediatric Physical Therapist	736	NC

General Provider Information

NPI Number	:	1699938126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANN K. CAMPBELL P.T.

Provider Business Mailing Address
First Line	:	1301 W MADISON ST
Second Line	:	#526
City	:	CHICAGO
State	:	IL
Zip	:	60607-1936
Country	:	US
Telephone Number	:	312-733-9604
Fax Number	:	312-733-0565

Provider Business Practice Location Address
First Line	:	1301 W MADISON ST
Second Line	:	#526
City	:	CHICAGO
State	:	IL
Zip	:	60607-1936
Country	:	US
Telephone Number	:	312-733-9604
Fax Number	:	312-733-0565

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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