Provider Demographics
NPI:1083022057
Name:CAMPBELL, REBECCA FAYE (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:FAYE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 WEST HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453
Mailing Address - Country:US
Mailing Address - Phone:352-419-7949
Mailing Address - Fax:352-419-7949
Practice Address - Street 1:2200 WEST HIGHWAY 44
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453
Practice Address - Country:US
Practice Address - Phone:352-419-7949
Practice Address - Fax:352-419-7949
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist