Provider Demographics
NPI:1720316839
Name:CAMPBELL, JASON OBERT SR (RMT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:OBERT
Last Name:CAMPBELL
Suffix:SR
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 ALCOTT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3817
Mailing Address - Country:US
Mailing Address - Phone:303-475-3387
Mailing Address - Fax:
Practice Address - Street 1:8400 ALCOTT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3817
Practice Address - Country:US
Practice Address - Phone:303-475-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9025225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist