Provider Demographics
NPI:1689693855
Name:CAMPBELL THERAPY CENTER LLC
Entity Type:Organization
Organization Name:CAMPBELL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:731-641-8111
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-0739
Mailing Address - Country:US
Mailing Address - Phone:731-641-8111
Mailing Address - Fax:731-641-8110
Practice Address - Street 1:109 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4917
Practice Address - Country:US
Practice Address - Phone:731-641-8111
Practice Address - Fax:731-641-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00103288OtherPALMETTO GBA RR MEDICARE
TN12115OtherVA
TN3729568Medicaid
TNP00103288OtherPALMETTO GBA RR MEDICARE
TN3729568Medicare PIN