Provider Demographics
NPI:1710099395
Name:CAMDEN, KEVIN D (PT, OCS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:CAMDEN
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6192 MUIRFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-7830
Mailing Address - Country:US
Mailing Address - Phone:815-547-4777
Mailing Address - Fax:815-547-1024
Practice Address - Street 1:522 S STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3709
Practice Address - Country:US
Practice Address - Phone:815-547-4777
Practice Address - Fax:815-547-1024
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK00938Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE