Provider Demographics
NPI:1598873093
Name:CAMPBELL, JOAN EPIFANIO (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:EPIFANIO
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 1:7490 EATON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7156
Mailing Address - Country:US
Mailing Address - Phone:954-989-7967
Mailing Address - Fax:954-989-7967
Practice Address - Street 1:550 SE 4TH CT
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4738
Practice Address - Country:US
Practice Address - Phone:954-925-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-0088712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics