Provider Demographics
NPI:1982906665
Name:CAMPBELL, DOROTHY ELEANOR
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ELEANOR
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 NE 91ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3129
Mailing Address - Country:US
Mailing Address - Phone:305-751-4564
Mailing Address - Fax:
Practice Address - Street 1:385 NE 91ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3129
Practice Address - Country:US
Practice Address - Phone:305-751-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22398225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant