Individual
IAN CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2195 W HILL RD, BOISE, ID 83702-0622
(208) 850-6995
(208) 323-9752
Mailing address
2195 W HILL RD, BOISE, ID 83702-0622
(208) 850-6995
(208) 323-9752
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-5047
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-5047
PT LICENSE
ID
Enumeration date
05/31/2017
Last updated
09/10/2020
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