Raymond G Campbell, PTA
Individual provider Active NPI Specialist · Luling, LA
NPI 1770715971 · NPPES record last updated Aug 20, 2009
Key facts
- NPI
- 1770715971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- A7469 (LA)
- Practice address
- 12371 Highway 90
Suite D
Luling, LA 70070-2371 - Phone
- (985) 331-1001
- Fax
- (985) 331-1005
- NPI assigned
- Aug 20, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A7469 | LA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River Region Rehab, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A7469 | LA | Yes |
Addresses
Primary practice location
12371 Highway 90
Suite D
Luling, LA 70070-2371
Mailing address
12371 Highway 90
Suite D
Luling, LA 70070-5114
Phone (985) 331-1001
Other providers in Luling, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.