MEDICARE: DR. KELLY ANNE CAMPBELL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305206518	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9383592	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740592351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ANNE CAMPBELL DPT

Provider Business Mailing Address
First Line	:	1100 GERMAN SCHOOL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4275
Country	:	US
Telephone Number	:	804-477-1914
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GERMAN SCHOOL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4275
Country	:	US
Telephone Number	:	804-477-1914
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	01/28/2015

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