Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06003037A | IN |
NPI | 1023142080 |
---|---|
Provider Name | Mrs. Lisa A Campbell |
First Address | Brownstown, IN 47220-9583 |
Second Address | Brownstown, IN 47220-9583 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |