Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | P12628 | NC |
N | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1356824395 |
---|---|
Provider Name | Jessica Campbell |
First Address | Franklin, TN 37064-8934 |
Second Address | King, NC 27021-8770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2018 |
Last Update Date | 08/11/2019 |