Provider Demographics
NPI:1376945972
Name:CAMPBELL, AMY SUZANNE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUZANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:SUZANNE
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:11700 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-3758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11700 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-3758
Practice Address - Country:US
Practice Address - Phone:303-340-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00006452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer