Healthcare Provider Details

I. General information

NPI: 1477384097
Provider Name (Legal Business Name): CAMPBELL PAIGE KUTACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 STONEBROOK PKWY STE 500
FRISCO TX
75034-1394
US

IV. Provider business mailing address

6226 FRISCO SQUARE BLVD APT 2040
FRISCO TX
75034-0161
US

V. Phone/Fax

Practice location:
  • Phone: 469-252-0433
  • Fax:
Mailing address:
  • Phone: 254-412-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1397188
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: