MEDICARE: MS. TERI S 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	PT00008123	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5863485	OTHER	WA	AETNA
2	9652CA	OTHER	WA	REGENCE

General Provider Information

NPI Number	:	1881801363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERI S CAMPBELL PT

Provider Business Mailing Address
First Line	:	3417 EVANSTON AVE N
Second Line	:	#414
City	:	SEATTLE
State	:	WA
Zip	:	98103-8626
Country	:	US
Telephone Number	:	206-930-7882
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 EVANSTON AVE N
Second Line	:	#414
City	:	SEATTLE
State	:	WA
Zip	:	98103-8626
Country	:	US
Telephone Number	:	206-930-7882
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	11/05/2012

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Directions to “ MS. TERI S CAMPBELL PT” Practice Location

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