MEDICARE: DUSTIN CAMPBELL PT, DPT

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	11308194-2401	UT

General Provider Information

NPI Number	:	1730961210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN CAMPBELL PT, DPT

Provider Business Mailing Address
First Line	:	6628 W SKIP ROCK RD
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-1754
Country	:	US
Telephone Number	:	385-202-1899
Fax Number	:

Provider Business Practice Location Address
First Line	:	5662 S COUGAR LN
Second Line	:
City	:	KEARNS
State	:	UT
Zip	:	84118-6055
Country	:	US
Telephone Number	:	385-202-1899
Fax Number	:

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

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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