Provider Demographics
NPI:1124442710
Name:CAMPBELL, TESSA MARIE (DPT)
Entity type:Individual
Prefix:MS
First Name:TESSA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 S GRAND CANYON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7173
Mailing Address - Country:US
Mailing Address - Phone:702-448-6042
Mailing Address - Fax:702-430-8970
Practice Address - Street 1:4215 S GRAND CANYON DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-480-6042
Practice Address - Fax:702-702-4308
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist