Provider Demographics
NPI:1013241108
Name:CAMPBELL, SUSAN JANE (MPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-8478
Mailing Address - Country:US
Mailing Address - Phone:256-810-8290
Mailing Address - Fax:
Practice Address - Street 1:101 E ELM ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1820
Practice Address - Country:US
Practice Address - Phone:256-810-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200621250AMedicaid