Provider Demographics
NPI:1427443993
Name:CAMPBELL, PAUL (LMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2424
Mailing Address - Country:US
Mailing Address - Phone:801-583-5692
Mailing Address - Fax:801-582-2074
Practice Address - Street 1:1515 S 1100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2424
Practice Address - Country:US
Practice Address - Phone:801-583-5692
Practice Address - Fax:801-582-2074
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4872999-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist