Provider Demographics
NPI:1720343254
Name:CAMPBELL, RYAN S (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S
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 1:450 POWERS AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5933
Mailing Address - Country:US
Mailing Address - Phone:717-920-4950
Mailing Address - Fax:717-920-4955
Practice Address - Street 1:450 POWERS AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5933
Practice Address - Country:US
Practice Address - Phone:717-920-4950
Practice Address - Fax:717-920-4955
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist