Provider Demographics
NPI:1811137508
Name:CAMPBELL, DAX CHRISTOPHER (PT)
Entity type:Individual
Prefix:MR
First Name:DAX
Middle Name:CHRISTOPHER
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:DAX
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:152 ISLIP AVE
Mailing Address - Street 2:STE. 15
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3225
Mailing Address - Country:US
Mailing Address - Phone:631-277-6767
Mailing Address - Fax:631-277-4311
Practice Address - Street 1:680 ROUTE 112 STE C
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1344
Practice Address - Country:US
Practice Address - Phone:631-289-3939
Practice Address - Fax:631-277-4311
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist