MEDICARE: MARYANN CAMPBELL LMT

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	MSG003327	PA

General Provider Information

NPI Number	:	1821568783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN CAMPBELL LMT

Provider Business Mailing Address
First Line	:	305 CAMP HOLLOW RD
Second Line	:
City	:	WEST MIFFLIN
State	:	PA
Zip	:	15122-2604
Country	:	US
Telephone Number	:	412-469-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 CAMP HOLLOW RD
Second Line	:
City	:	WEST MIFFLIN
State	:	PA
Zip	:	15122-2604
Country	:	US
Telephone Number	:	412-469-9600
Fax Number	:

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

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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