Provider Demographics
NPI:1265664155
Name:CAMPBELL, KRISTEN KNIGHTLY (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KNIGHTLY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3520
Mailing Address - Country:US
Mailing Address - Phone:619-501-2195
Mailing Address - Fax:619-501-2176
Practice Address - Street 1:1333 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-501-2195
Practice Address - Fax:619-501-2176
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist