Provider Demographics
NPI:1962971697
Name:CAMPBELL, ANDREW STEVEN (LMT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:STEVEN
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:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1264
Mailing Address - Country:US
Mailing Address - Phone:208-818-0245
Mailing Address - Fax:
Practice Address - Street 1:1625 N 4TH ST STE 203
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6178
Practice Address - Country:US
Practice Address - Phone:208-765-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3113225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist