Provider Demographics
NPI:1932140548
Name:CAMPBELL, KATHLEEN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
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 1:27344 WATKIN RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1784
Mailing Address - Country:US
Mailing Address - Phone:440-427-0599
Mailing Address - Fax:
Practice Address - Street 1:3035 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4144
Practice Address - Country:US
Practice Address - Phone:440-356-9103
Practice Address - Fax:440-333-0910
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT009557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA4124212Medicare PIN