Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 9759 | FL |
Y | 2251X0800X | Physical Therapist - Orthopedic | 9759 | FL |
NPI | 1124304027 |
---|---|
Provider Name | Dr. Lance Mathew Campbell |
First Address | Panama City, FL 32405-1910 |
Second Address | Callaway, FL 32404-9495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 25/10/2011 |