Provider Demographics
NPI:1174211890
Name:CAMPBELL, ROBERT BOBBY (PTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BOBBY
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 WILLOWVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3973
Mailing Address - Country:US
Mailing Address - Phone:763-439-3698
Mailing Address - Fax:
Practice Address - Street 1:1550 RAYDALE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5031
Practice Address - Country:US
Practice Address - Phone:502-968-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04349208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation