Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | DAPT001107 | PA |
NPI | 1306903117 |
---|---|
Provider Name | Gregory Campbell |
First Address | Pittsburgh, PA 15238-3126 |
Second Address | Pittsburgh, PA 15238-3126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |