Provider Demographics
NPI:1639324155
Name:CAMPBELL, ADAM L (DPT)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S ENGLISH STATION RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4160
Mailing Address - Country:US
Mailing Address - Phone:812-697-2127
Mailing Address - Fax:
Practice Address - Street 1:5170 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8400
Practice Address - Country:US
Practice Address - Phone:812-590-8888
Practice Address - Fax:812-590-8890
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
KY0051082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11912635OtherCAQH
KY0905811Medicare UPIN