Provider Demographics
NPI:1003951971
Name:CAMPBELL, CORRINE F (PT)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:F
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CORRINE
Other - Middle Name:F
Other - Last Name:MCNAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4828 EASTSIDE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870
Mailing Address - Country:US
Mailing Address - Phone:406-777-2679
Mailing Address - Fax:406-777-3586
Practice Address - Street 1:4828 EASTSIDE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870
Practice Address - Country:US
Practice Address - Phone:406-777-2679
Practice Address - Fax:406-777-3586
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT06160-8OtherBCBSMT PROVIDER #
MT06160-8OtherBCBS
MT000050673Medicare PIN