Basic Information
| Provider Information | |||||||||
| NPI: | 1194386334 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPEAU | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | BROWNING | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 257 DESTINY DR | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993628816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095404334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7411 N NEVADA ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992085518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094892273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2019 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 60936486 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.