Healthcare Provider Details

I. General information

NPI: 1598873093
Provider Name (Legal Business Name): JOAN EPIFANIO CAMPBELL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SE 4TH CT
DANIA BEACH FL
33004-4738
US

IV. Provider business mailing address

7490 EATON ST
HOLLYWOOD FL
33024-7156
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-7034
  • Fax:
Mailing address:
  • Phone: 954-989-7967
  • Fax: 954-989-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-008871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: