Provider Demographics
NPI:1578992723
Name:CAMPBELL, ADAM (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2840
Mailing Address - Country:US
Mailing Address - Phone:817-451-4994
Mailing Address - Fax:817-457-6681
Practice Address - Street 1:5900 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2840
Practice Address - Country:US
Practice Address - Phone:817-451-4994
Practice Address - Fax:817-457-6681
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer