Provider Demographics
NPI:1871031609
Name:CAMPBELL, TRISHA L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1533
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1533
Mailing Address - Country:US
Mailing Address - Phone:270-304-6981
Mailing Address - Fax:
Practice Address - Street 1:3630 GLEN LILY RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-7896
Practice Address - Country:US
Practice Address - Phone:270-282-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist