Provider Demographics
NPI:1912225525
Name:CAMPBELL, KELLY R (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:901 ENTERPRISE PKWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6249
Mailing Address - Country:US
Mailing Address - Phone:757-827-2481
Mailing Address - Fax:
Practice Address - Street 1:901 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6249
Practice Address - Country:US
Practice Address - Phone:757-827-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052026522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic