Provider Demographics
NPI:1740592351
Name:CAMPBELL, KELLY ANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:DOWNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 GERMAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4275
Mailing Address - Country:US
Mailing Address - Phone:804-477-1914
Mailing Address - Fax:
Practice Address - Street 1:1100 GERMAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4275
Practice Address - Country:US
Practice Address - Phone:804-477-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9383592OtherAETNA
VA1740592351Medicaid
VAC05954Medicare PIN