Provider Demographics
NPI:1962014829
Name:CAMPBELL, TIMOTHY DEAN JR (PTA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DEAN
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S LINCOLN ST APT 207
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1653
Mailing Address - Country:US
Mailing Address - Phone:303-386-5395
Mailing Address - Fax:
Practice Address - Street 1:60 S LINCOLN ST APT 207
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-1653
Practice Address - Country:US
Practice Address - Phone:303-386-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014818225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant