Provider Demographics
NPI:1982655221
Name:CAMPBELL, VERONIKA MARIE (PT, MPT, CSCS, NSC)
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT, MPT, CSCS, NSC
Other - Prefix:
Other - First Name:VERONIKA
Other - Middle Name:MARIE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:20325 N 51ST AVE SUITE #134
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:313-461-3805
Mailing Address - Fax:
Practice Address - Street 1:20325 N 51ST AVE SUITE 134
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:313-461-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2Z7238OtherHEALTHNET
AZ1386864262OtherBCBS
AZ109210Medicare PIN
AZ1386864262OtherBCBS