Provider Demographics
NPI:1851812622
Name:CAMPBELL, KIRSTEN ANNA (PT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANNA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 E SINTO AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2199
Mailing Address - Country:US
Mailing Address - Phone:509-789-2956
Mailing Address - Fax:097-892-9765
Practice Address - Street 1:12410 E SINTO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2199
Practice Address - Country:US
Practice Address - Phone:509-789-2956
Practice Address - Fax:097-892-9765
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60744258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1851812622Medicaid
WAG8968425OtherMEDICARE