Provider Demographics
NPI:1245802651
Name:CAMPBELL, DUSTIN J (LMT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3167
Mailing Address - Country:US
Mailing Address - Phone:813-777-5971
Mailing Address - Fax:
Practice Address - Street 1:645 3RD AVE N
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3167
Practice Address - Country:US
Practice Address - Phone:813-777-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA84709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist