Provider Demographics
NPI:1780684555
Name:CAMPBELL ORTHOPAEDIC PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:CAMPBELL ORTHOPAEDIC PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-396-4825
Mailing Address - Street 1:3740 E SOUTHERN AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2568
Mailing Address - Country:US
Mailing Address - Phone:480-396-4825
Mailing Address - Fax:480-396-4896
Practice Address - Street 1:3740 E SOUTHERN AVE
Practice Address - Street 2:STE 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2568
Practice Address - Country:US
Practice Address - Phone:480-396-4825
Practice Address - Fax:480-396-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RPT 1220Medicare ID - Type Unspecified
R74891Medicare UPIN