=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376574251
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI WARNER CAMPBELL PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8016 W GULF TO LAKE HWY
-----------------------------------------------------
City | CRYSTAL RIVER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34429-7928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-564-2738
-----------------------------------------------------
Fax | 352-795-0990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8016 W GULF TO LAKE HWY
-----------------------------------------------------
City | CRYSTAL RIVER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34429-7928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-564-2738
-----------------------------------------------------
Fax | 352-795-0990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT22728
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------