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General NPI Number Information
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NPI Number | 1124304027
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Entity Type | Individual
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Provider Name | LANCE MATHEW CAMPBELL DHSC, MSCPT, MTC
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Gender | Male
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 807 N TYNDALL PKWY
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City | CALLAWAY
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State | FL
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Zip | 32404-9495
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Country | US
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Telephone | 850-819-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 120 QUEENS CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-1910
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Country | US
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Telephone | 850-747-1198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 9759
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 9759
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License Number State | FL
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