Healthcare Provider Details

I. General information

NPI: 1578179891
Provider Name (Legal Business Name): KIRSTEN CAMPBELL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 JOHNNY MERCER BLVD STE C2
SAVANNAH GA
31410-2221
US

IV. Provider business mailing address

6397 LEE HWY
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 912-231-3619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP011431T
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305213913
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: