Healthcare Provider Details

I. General information

NPI: 1386552545
Provider Name (Legal Business Name): ALLAYNA CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 STATE HIGHWAY P
POTOSI MO
63664-8486
US

IV. Provider business mailing address

904 GLENCOE
PARK HILLS MO
63601-1931
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-2223
  • Fax:
Mailing address:
  • Phone: 573-327-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2025019791
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: