MEDICARE: MS. JILL MARIE 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	5058	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	187220	OTHER		MEDCOST
2	067XH	OTHER		BCBS

General Provider Information

NPI Number	:	1912082702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL MARIE CAMPBELL PT

Provider Business Mailing Address
First Line	:	380 BREVARD RD
Second Line	:	ASTON PARK HEALTHCARE CENTER
City	:	ASHEVILLE
State	:	NC
Zip	:	28806-2945
Country	:	US
Telephone Number	:	828-283-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 BREVARD RD
Second Line	:	ASTON PARK HEALTHCARE CENTER
City	:	ASHEVILLE
State	:	NC
Zip	:	28806-2945
Country	:	US
Telephone Number	:	828-283-0026
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	05/01/2015

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