Individual
KEVIN CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
474 S LANDMARK AVE, BLOOMINGTON, IN 47403-5000
(812) 727-3651
Mailing address
3524 S WICKENS ST, BLOOMINGTON, IN 47403-4514
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06003728A
IN
2255A2300X
Athletic Trainer
Primary
36001279A
IN
Other
Enumeration date
08/21/2014
Last updated
09/17/2019
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