Provider Demographics
NPI:1871979195
Name:CAMPBELL, SHEA KL (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:SHEA
Middle Name:KL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12691 W SMOKEY DR STE 128
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-3801
Mailing Address - Country:US
Mailing Address - Phone:623-234-4171
Mailing Address - Fax:623-234-4173
Practice Address - Street 1:12691 W SMOKEY DR STE 128
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-3801
Practice Address - Country:US
Practice Address - Phone:623-234-4171
Practice Address - Fax:623-234-4173
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ117262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic