Provider Demographics
NPI:1194386334
Name:CAMPEAU, JACOB BROWNING (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:BROWNING
Last Name:CAMPEAU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 DESTINY DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8816
Mailing Address - Country:US
Mailing Address - Phone:509-540-4334
Mailing Address - Fax:
Practice Address - Street 1:7411 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5518
Practice Address - Country:US
Practice Address - Phone:509-489-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
60936486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist