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General NPI Number Information
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NPI Number | 1568131258
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Entity Type | Individual
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Provider Name | MIEKA ALICIA CAMPBELL LMT
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Gender | Female
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 8497 S US HIGHWAY 1
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-3360
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Country | US
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Telephone | 772-800-8728
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Fax | 772-212-7026
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Provider Business Mailing Address
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Address Line | 5713 BUCHANAN DR
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City | FORT PIERCE
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State | FL
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Zip | 34982-3253
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Country | US
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Telephone | 352-454-8881
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Fax | 772-212-7026
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA40822
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License Number State | FL
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