Provider Demographics
NPI:1215218714
Name:CAMPBELL, MELISSA GAIL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GAIL
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 1:406 ROY MARTIN RD
Mailing Address - Street 2:SUITE#1
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2244
Mailing Address - Country:US
Mailing Address - Phone:423-943-3567
Mailing Address - Fax:
Practice Address - Street 1:406 ROY MARTIN RD
Practice Address - Street 2:SUITE#1
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-2244
Practice Address - Country:US
Practice Address - Phone:423-943-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7203225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist