Provider Demographics
NPI:1932602000
Name:CAMPBELL, THOMAS A (LMT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4397 OPPOSUM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:WV
Mailing Address - Zip Code:25862-6223
Mailing Address - Country:US
Mailing Address - Phone:304-640-3642
Mailing Address - Fax:
Practice Address - Street 1:325 JONES AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2908
Practice Address - Country:US
Practice Address - Phone:304-465-4325
Practice Address - Fax:304-465-4320
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2018-3581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist