MEDICARE: JORDAN L CAMPBELL PT, DPT, LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5481	AR
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1093380354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN L CAMPBELL PT, DPT, LAT, ATC

Provider Business Mailing Address
First Line	:	250 STURGIS RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8334
Country	:	US
Telephone Number	:	501-513-7903
Fax Number	:	501-358-6264

Provider Business Practice Location Address
First Line	:	250 STURGIS RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8334
Country	:	US
Telephone Number	:	501-513-7903
Fax Number	:	501-358-6264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	08/01/2024

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Directions to “ JORDAN L CAMPBELL PT, DPT, LAT, ATC” Practice Location

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