Provider Demographics
NPI:1164731956
Name:CAMPBELL, KEVIN JAMES (LMT, BCTMB)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59834-0827
Mailing Address - Country:US
Mailing Address - Phone:406-390-0131
Mailing Address - Fax:406-390-2196
Practice Address - Street 1:16840 BECKWITH ST STE 2
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834-9650
Practice Address - Country:US
Practice Address - Phone:406-390-0131
Practice Address - Fax:406-390-2196
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTLMTLMTLIC-3OtherSTATE OF MONTANA DEPARTMENT OF LABOR AND INDUSTRY BOARD OF MASSAGE THERAPY
MT538979-07OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK
MT81-0542478OtherFEDERAL TAX I.D. NUMBER