Healthcare Provider Details

I. General information

NPI: 1598193823
Provider Name (Legal Business Name): LAURA MAHALA CAMPBELL P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MAHALA HANKINS & SCOTT P.T.

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 OLD HIGHWAY 40
BATES CITY MO
64011-8229
US

IV. Provider business mailing address

205 OLD HIGHWAY 40
BATES CITY MO
64011-8229
US

V. Phone/Fax

Practice location:
  • Phone: 816-419-5519
  • Fax:
Mailing address:
  • Phone: 816-419-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberR1369
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: