Healthcare Provider Details

I. General information

NPI: 1265386205
Provider Name (Legal Business Name): MS. KYLIE E CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13995 W STATLER BLVD STE 165
SURPRISE AZ
85374-5517
US

IV. Provider business mailing address

PO BOX 29708
BELFAST ME
04915-2049
US

V. Phone/Fax

Practice location:
  • Phone: 866-974-2673
  • Fax: 866-939-2673
Mailing address:
  • Phone: 866-824-2673
  • Fax: 855-650-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034874
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: