Provider Demographics
NPI:1962671040
Name:CAMPBELL, STEVEN D (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 E SOUTHERN AVE STE 105
Mailing Address - Street 2:
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 STE 105
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR74891Medicare UPIN
AZRPT1220Medicare PIN