Provider Demographics
NPI:1356609655
Name:CAMPBELL, TIMOTHY PERROW (LMT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PERROW
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NAMBE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3817
Mailing Address - Country:US
Mailing Address - Phone:505-795-0467
Mailing Address - Fax:
Practice Address - Street 1:201 NAMBE ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3817
Practice Address - Country:US
Practice Address - Phone:505-795-0467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6487225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist