Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1402 | SC |
NPI | 1003172966 |
---|---|
Provider Name | Ms. Rebecca Trotman Campbell |
First Address | Mount Pleasant, SC 29464-3584 |
Second Address | Mount Pleasant, SC 29464-3584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 05/04/2012 |