Provider Demographics
NPI:1063962025
Name:CAMPBELL, KIMBERLY ANN (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:KEATHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2400 BAHAMAS DR
Mailing Address - Street 2:100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0745
Mailing Address - Country:US
Mailing Address - Phone:661-328-5565
Mailing Address - Fax:661-328-5573
Practice Address - Street 1:2400 BAHAMAS DR
Practice Address - Street 2:100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0745
Practice Address - Country:US
Practice Address - Phone:661-328-5565
Practice Address - Fax:661-328-5573
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
CAPT2927622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant