Healthcare Provider Details

I. General information

NPI: 1811241581
Provider Name (Legal Business Name): CAMDEN H CAMPBELL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 US HIGHWAY 23 S SUITE 4
PIKEVILLE KY
41501-3701
US

IV. Provider business mailing address

251 MEDICAL PLAZA LN SUITE D
WHITESBURG KY
41858-9323
US

V. Phone/Fax

Practice location:
  • Phone: 606-639-1200
  • Fax: 606-639-1020
Mailing address:
  • Phone: 606-632-1188
  • Fax: 606-632-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006245
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: