Provider Demographics
NPI:1851384853
Name:CAMPBELL, AMY ELIZABETH (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9860 FAIRFAX BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1737
Mailing Address - Country:US
Mailing Address - Phone:703-383-1616
Mailing Address - Fax:703-383-1166
Practice Address - Street 1:9860 FAIRFAX BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1737
Practice Address - Country:US
Practice Address - Phone:703-383-1616
Practice Address - Fax:703-383-1166
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist