Provider Demographics
NPI:1578018297
Name:CAMPBELL, JEN (MSPT)
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 PERIMETER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3247
Mailing Address - Country:US
Mailing Address - Phone:614-355-9561
Mailing Address - Fax:614-355-9570
Practice Address - Street 1:5700 PERIMETER DR
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3247
Practice Address - Country:US
Practice Address - Phone:614-355-9561
Practice Address - Fax:614-355-9570
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH109922251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics