Provider Demographics
NPI:1952843161
Name:CAMPBELL, STEVEN LEE (PTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7392 YARROW RUN RD
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-7614
Mailing Address - Country:US
Mailing Address - Phone:614-546-4497
Mailing Address - Fax:
Practice Address - Street 1:6001 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1502
Practice Address - Country:US
Practice Address - Phone:614-546-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHPTA011180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program