Provider Demographics
NPI:1295133213
Name:CAMPBELL, TITIA (LMT)
Entity type:Individual
Prefix:
First Name:TITIA
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 1:6401 KELLY ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5131
Mailing Address - Country:US
Mailing Address - Phone:817-690-4462
Mailing Address - Fax:
Practice Address - Street 1:6040 CAMP BOWIE BLVD
Practice Address - Street 2:17
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5612
Practice Address - Country:US
Practice Address - Phone:817-690-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM117034225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist