Provider Demographics
NPI:1275143729
Name:CAMPBELL, AMANDA (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 STEVENSON DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-9566
Mailing Address - Country:US
Mailing Address - Phone:937-564-4283
Mailing Address - Fax:
Practice Address - Street 1:9310 KELCH RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9679
Practice Address - Country:US
Practice Address - Phone:937-564-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist