Provider Demographics
NPI:1215409925
Name:CAMPBELL, JOHN LAMAR II (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAMAR
Last Name:CAMPBELL
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MORELLA RD
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38233-3270
Mailing Address - Country:US
Mailing Address - Phone:731-446-6500
Mailing Address - Fax:
Practice Address - Street 1:1636 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2026
Practice Address - Country:US
Practice Address - Phone:731-285-6400
Practice Address - Fax:731-287-8607
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5714225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant