Healthcare Provider Details

I. General information

NPI: 1689693855
Provider Name (Legal Business Name): CAMPBELL THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 COMMERCE ST
PARIS TN
38242-4917
US

IV. Provider business mailing address

PO BOX 739
DOVER TN
37058-0739
US

V. Phone/Fax

Practice location:
  • Phone: 731-641-8111
  • Fax: 731-641-8110
Mailing address:
  • Phone: 731-641-8111
  • Fax: 731-641-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateTN

VIII. Authorized Official

Name: MRS. SHANI DEVON CAMPBELL
Title or Position: CEO
Credential: PT
Phone: 731-641-8111