Provider Demographics
NPI:1699070680
Name:CAMPBELL, ASHLEY (LMT)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 NW 27TH COURT SUITE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:352-377-6008
Mailing Address - Fax:352-377-7364
Practice Address - Street 1:4909 NW 27TH CT
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6509
Practice Address - Country:US
Practice Address - Phone:352-377-6008
Practice Address - Fax:352-377-7364
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL52513172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist