Healthcare Provider Details

I. General information

NPI: 1407798861
Provider Name (Legal Business Name): MICHAEL CAMPBELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 BETHLEHEM PIKE STE 10
SPRING HOUSE PA
19477-1102
US

IV. Provider business mailing address

1121 BETHLEHEM PIKE STE 10
SPRING HOUSE PA
19477-1102
US

V. Phone/Fax

Practice location:
  • Phone: 267-642-1642
  • Fax:
Mailing address:
  • Phone: 267-642-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE012624
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: