Provider Demographics
NPI:1902353857
Name:CAMPBELL, OLIVIA ELAINE (DPT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ELAINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ELAINE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2531 ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4415
Mailing Address - Country:US
Mailing Address - Phone:205-978-7376
Mailing Address - Fax:205-978-0861
Practice Address - Street 1:2703 LEGENDS PKWY
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7755
Practice Address - Country:US
Practice Address - Phone:334-380-4930
Practice Address - Fax:334-380-4931
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist