Provider Demographics
NPI:1215130638
Name:CAMPTON PHYSICAL THERAPY
Entity type:Organization
Organization Name:CAMPTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-693-0531
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0790
Mailing Address - Country:US
Mailing Address - Phone:606-693-0531
Mailing Address - Fax:606-693-0535
Practice Address - Street 1:240 HWY 15 SOUTH
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-0790
Practice Address - Country:US
Practice Address - Phone:606-693-0531
Practice Address - Fax:606-693-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8876Medicare ID - Type UnspecifiedKY MEDICARE GROUP