Provider Demographics
NPI:1376574251
Name:CAMPBELL, JODI WARNER (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:WARNER
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 1:8016 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7928
Mailing Address - Country:US
Mailing Address - Phone:352-564-2738
Mailing Address - Fax:352-795-0990
Practice Address - Street 1:8016 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7928
Practice Address - Country:US
Practice Address - Phone:352-564-2738
Practice Address - Fax:352-795-0990
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist