Provider Demographics
NPI:1659581866
Name:CAMPBELL, JOHN DANIEL (MPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 BONITA CT
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-3509
Mailing Address - Country:US
Mailing Address - Phone:239-877-4449
Mailing Address - Fax:
Practice Address - Street 1:40 S HEATHWOOD DR
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-5026
Practice Address - Country:US
Practice Address - Phone:239-393-4079
Practice Address - Fax:239-642-8484
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist