Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3448 | MS |
N | 2251N0400X | Physical Therapist - Neurology | 3448 | MS |
N | 2251X0800X | Physical Therapist - Orthopedic | 3448 | MS |
NPI | 1336496363 |
---|---|
Provider Name | Lea Marie Campbell |
First Address | Ocean Springs, MS 39564-5045 |
Second Address | Ocean Springs, MS 39564-5045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2012 |
Last Update Date | 09/08/2012 |