Healthcare Provider Details

I. General information

NPI: 1093374597
Provider Name (Legal Business Name): SYMIAH SHIANNE CAMPBELL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 E FLORIDA AVE STE 330
DENVER CO
80210-2546
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 303-370-2670
  • Fax:
Mailing address:
  • Phone: 323-865-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.0021256
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: