Provider Demographics
NPI:1467801035
Name:CAMPBELL, STEPHANIE M (PT, DPT, FAAOMPT)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT, DPT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WELTON WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9251
Mailing Address - Country:US
Mailing Address - Phone:704-660-6551
Mailing Address - Fax:704-660-9894
Practice Address - Street 1:114 WELTON WAY
Practice Address - Street 2:SUITE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9251
Practice Address - Country:US
Practice Address - Phone:704-660-6551
Practice Address - Fax:704-660-9894
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P15763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist