Individual
MR. ANDREW STEVEN CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1625 N 4TH ST STE 203, COEUR D ALENE, ID 83814-6178
(208) 765-1075
Mailing address
PO BOX 1264, HAYDEN, ID 83835-1264
(208) 818-0245
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3113
ID
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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