Provider Demographics
NPI:1003297094
Name:CAMPBELL, KYLE (PTA)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2493 MILFORD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9720
Mailing Address - Country:US
Mailing Address - Phone:570-424-1706
Mailing Address - Fax:
Practice Address - Street 1:2493 MILFORD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9720
Practice Address - Country:US
Practice Address - Phone:570-424-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003609225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant