Provider Demographics
NPI:1043623705
Name:CAMPBELL, MARIN LEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARIN
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7433 SINGING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3769
Mailing Address - Country:US
Mailing Address - Phone:970-620-0569
Mailing Address - Fax:
Practice Address - Street 1:7433 SINGING HILLS DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3769
Practice Address - Country:US
Practice Address - Phone:970-620-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO126672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic