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NPI Code Detail

MEDICARE: DR. LANCE MATHEW CAMPBELL DHSC, MSCPT, MTC

MEDICARE: DR. LANCE MATHEW CAMPBELL DHSC, MSCPT, MTC
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
12251G0304XGeriatric Physical Therapist9759FL
22251X0800XOrthopedic Physical Therapist9759FL

General Provider Information

NPI Number : 1124304027
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANCE MATHEW CAMPBELL DHSC, MSCPT, MTC
Provider Business Mailing Address
First Line : 120 QUEENS CIR
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-1910
Country : US
Telephone Number : 850-747-1198
Fax Number :
Provider Business Practice Location Address
First Line : 807 N TYNDALL PKWY
Second Line :
City : CALLAWAY
State : FL
Zip : 32404-9495
Country : US
Telephone Number : 850-819-1937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2011
Last Update Date : 10/25/2011

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