Provider Demographics
NPI:1972804623
Name:CAMPBELL, TUDIE (LMT)
Entity Type:Individual
Prefix:
First Name:TUDIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PAULS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4801
Mailing Address - Country:US
Mailing Address - Phone:813-643-1242
Mailing Address - Fax:
Practice Address - Street 1:330 PAULS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4801
Practice Address - Country:US
Practice Address - Phone:813-643-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 47791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist