Provider Demographics
NPI:1437456969
Name:CAMPBELL, OWEN (PT)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1076 W CHANDLER BLVD
Mailing Address - Street 2:103
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5225
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-1887
Practice Address - Street 1:3700 N 24TH ST
Practice Address - Street 2:230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6534
Practice Address - Country:US
Practice Address - Phone:602-309-4383
Practice Address - Fax:602-714-5483
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2014-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY033449-1225100000X
AZ10709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist