Provider Demographics
NPI:1255070769
Name:CAMPBELL, AMANDA LOVE (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOVE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LOVE
Other - Last Name:MANGELO-POMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:9217 CHIEFTAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1017
Mailing Address - Country:US
Mailing Address - Phone:719-452-1363
Mailing Address - Fax:
Practice Address - Street 1:3001 S ACADEMY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-3269
Practice Address - Country:US
Practice Address - Phone:719-428-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019408225100000X
TXAT93612255A2300X
COMSPTL.0000030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer