Healthcare Provider Details

I. General information

NPI: 1861446627
Provider Name (Legal Business Name): LANCE BAKER CAMPBELL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 SHIPYARD BLVD
WILMINGTON NC
28403-6148
US

IV. Provider business mailing address

2716 ASHTON DR
WILMINGTON NC
28412-2489
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-8000
  • Fax: 910-251-0421
Mailing address:
  • Phone: 910-332-3800
  • Fax: 910-251-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10909
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: