Individual
MARY ELLEN CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2 ESSEX CENTER DR, PEABODY, MA 01960-2902
(978) 977-4115
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
557
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B267
HARVARD PILGRIM
MA
Enumeration date
04/14/2006
Last updated
04/07/2009
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