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General NPI Number Information
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NPI Number | 1821719873
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Entity Type | Individual
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Provider Name | JACOB WADE CAMPBELL
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Gender | Male
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 3533 S ALAMEDA ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-1721
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Country | US
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Telephone | 361-694-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 8808 HIGHWAY 81 S
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City | STARR
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State | SC
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Zip | 29684-9413
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1393541
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License Number State | TX
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