Provider Demographics
NPI:1821252792
Name:CAMPBELL, ARDER 'SCOTT' (PT)
Entity Type:Individual
Prefix:MR
First Name:ARDER
Middle Name:'SCOTT'
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 CRISP DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7771
Mailing Address - Country:US
Mailing Address - Phone:919-847-8753
Mailing Address - Fax:919-847-8753
Practice Address - Street 1:1640 EVA MAE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4443
Practice Address - Country:US
Practice Address - Phone:800-362-0903
Practice Address - Fax:866-434-5096
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14979OtherBLUECROSS BLUESHIELD OF NORTH CAROLINA
NC14979OtherBLUECROSS BLUESHIELD OF NORTH CAROLINA