Provider Demographics
NPI:1649491325
Name:CAMPBELL, SAMANTHA MARIE (ATC, CSCS, LMT)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ATC, CSCS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81536
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-1536
Mailing Address - Country:US
Mailing Address - Phone:808-214-8224
Mailing Address - Fax:808-442-1140
Practice Address - Street 1:810 KOKOMO RD
Practice Address - Street 2:SUITE 159
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5075
Practice Address - Country:US
Practice Address - Phone:808-214-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12265174400000X
HIAT-187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist