Provider Demographics
NPI:1225678568
Name:CAMPBELL, KIRSTEN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E MARSHALL ST APT 435
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7389
Mailing Address - Country:US
Mailing Address - Phone:304-702-7080
Mailing Address - Fax:
Practice Address - Street 1:8200 MEADOWBRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2337
Practice Address - Country:US
Practice Address - Phone:804-730-2121
Practice Address - Fax:804-730-0563
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260032772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer