MEDICARE: JOHN CAMPBELL PT

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
2	225100000X	Physical Therapist	070003674	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070-003674	OTHER	IL	PT STATE LICENSE #

General Provider Information

NPI Number	:	1205991619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CAMPBELL PT

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR.
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	530 W NORTH ST
Second Line	:	SUITE 101
City	:	MANHATTAN
State	:	IL
Zip	:	60442-8176
Country	:	US
Telephone Number	:	815-478-7444
Fax Number	:	815-478-7447

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	06/15/2017

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Directions to “ JOHN CAMPBELL PT” Practice Location

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