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General NPI Number Information
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NPI Number | 1740436179
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Entity Type | Organization
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Legal Business Name | CAMPBELL PEDORTHICS, LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 1520 HUGUENOT RD SUITE 114
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-2477
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Country | US
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Telephone | 804-794-0070
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Fax | 804-794-0072
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Provider Business Mailing Address
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Address Line | 11306 EASTCLIFF DR
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City | RICHMOND
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State | VA
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Zip | 23236-2480
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Country | US
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Telephone | 804-794-0070
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Fax | 804-794-0072
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT JAMES CAMPBELL
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Credential | C.PED.
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Telephone | 804-794-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CPED0774
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License Number State | DE
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