Provider Demographics
NPI:1730961210
Name:CAMPBELL, DUSTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 W SKIP ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1754
Mailing Address - Country:US
Mailing Address - Phone:385-202-1899
Mailing Address - Fax:
Practice Address - Street 1:5662 S COUGAR LN
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-6055
Practice Address - Country:US
Practice Address - Phone:385-202-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11308194-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist