Healthcare Provider Details

I. General information

NPI: 1164731956
Provider Name (Legal Business Name): KEVIN JAMES CAMPBELL LMT, BCTMB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16840 BECKWITH ST STE 2
FRENCHTOWN MT
59834-9650
US

IV. Provider business mailing address

PO BOX 827
FRENCHTOWN MT
59834-0827
US

V. Phone/Fax

Practice location:
  • Phone: 406-390-0131
  • Fax: 406-390-2196
Mailing address:
  • Phone: 406-390-0131
  • Fax: 406-390-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLMT-LMT-LIC-3
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-3
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: