Provider Demographics
NPI:1073990966
Name:CAMPBELL, ALEXANDRA CLAIRE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:CLAIRE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 LENOX NAUVOO RD
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-7003
Mailing Address - Country:US
Mailing Address - Phone:731-676-3700
Mailing Address - Fax:
Practice Address - Street 1:765 BERT JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2414
Practice Address - Country:US
Practice Address - Phone:731-676-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5015225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant