Provider Demographics
NPI:1184633992
Name:CAMPBELL, ANNE H (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:H
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 COLLEGE PARK DR
Mailing Address - Street 2:STE 109
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4001
Mailing Address - Country:US
Mailing Address - Phone:936-273-1095
Mailing Address - Fax:936-273-1074
Practice Address - Street 1:3115 COLLEGE PARK DR
Practice Address - Street 2:STE 109
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4001
Practice Address - Country:US
Practice Address - Phone:936-273-1095
Practice Address - Fax:936-273-1074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82122TOtherBLUE CROSS BLUE SHIELD
TX82122TOtherBLUE CROSS BLUE SHIELD
TX760436269Medicare UPIN
TX00164SMedicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #