Provider Demographics
NPI:1386779593
Name:CAMPBELL, TRAVIS (PT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22510 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:GLOUSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45732-9726
Mailing Address - Country:US
Mailing Address - Phone:740-856-2017
Mailing Address - Fax:740-767-2904
Practice Address - Street 1:22510 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:GLOUSTER
Practice Address - State:OH
Practice Address - Zip Code:45732-9726
Practice Address - Country:US
Practice Address - Phone:740-856-2017
Practice Address - Fax:740-767-2904
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist