MEDICARE: KENNEY CAMPBELL

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	225700000X	Massage Therapist	MT122234	TX

General Provider Information

NPI Number	:	1225536295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEY CAMPBELL

Provider Business Mailing Address
First Line	:	6752 THADDEUS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6641
Country	:	US
Telephone Number	:	682-667-2721
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 AMADOR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2227
Country	:	US
Telephone Number	:	682-667-2721
Fax Number	:

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

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	01/24/2018

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Directions to “ KENNEY CAMPBELL ” Practice Location

Language	Start Address	Practice Location

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