Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 12667 | CO |
NPI | 1043623705 |
---|---|
Provider Name | Marin Lee Campbell |
First Address | Boulder, CO 80301-3769 |
Second Address | Boulder, CO 80301-3769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 10/05/2017 |