Provider Demographics
NPI:1790963247
Name:CAMPBELL, CRAIG (DPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9053 BLACKRABBIT RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-9222
Mailing Address - Country:US
Mailing Address - Phone:937-393-0526
Mailing Address - Fax:
Practice Address - Street 1:1991 CROCKER RD STE 600A
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6969
Practice Address - Country:US
Practice Address - Phone:614-285-6274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007161225100000X
OHPT007161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist