Provider Demographics
NPI:1114031408
Name:CAMPBELL, AMY J (MSPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7501
Mailing Address - Country:US
Mailing Address - Phone:989-832-6485
Mailing Address - Fax:989-832-6485
Practice Address - Street 1:5319 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-7501
Practice Address - Country:US
Practice Address - Phone:989-832-6485
Practice Address - Fax:989-832-6485
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011947261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy