Provider Demographics
NPI:1104999408
Name:CAMPBELL, MARISSA (PT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:ALMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:
Practice Address - Street 1:690 COOPER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-0000
Practice Address - Country:US
Practice Address - Phone:480-503-2100
Practice Address - Fax:480-503-2131
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ74512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ64890OtherMEDICARE GROUP NUMBER
AZ120665Medicare PIN