Basic Information
| Provider Information | |||||||||
| NPI: | 1427223965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | LINNETT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHAMBERS | ||||||||
| OtherFirstName: | WANDA | ||||||||
| OtherMiddleName: | LINNETT | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2405 ATHERHOLT RD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344858500 | ||||||||
| FaxNumber: | 4344858599 | ||||||||
| Practice Location | |||||||||
| Address1: | 2405 ATHERHOLT RD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344858500 | ||||||||
| FaxNumber: | 4344858599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2008 | ||||||||
| LastUpdateDate: | 05/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305002998 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1427223965 | 05 | VA | MEDICAID | P00686683 | 01 | VA | MEDICARE RAILROAD | OTHER |