Provider Demographics
NPI:1699913244
Name:CAMPBELL, KRISTA ROSE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ROSE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ROSE
Other - Last Name:SHIWARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2000 CLIFFMINE RD
Mailing Address - Street 2:PARK WEST TWO, SUITE 110
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1008
Mailing Address - Country:US
Mailing Address - Phone:412-494-4550
Mailing Address - Fax:412-494-6094
Practice Address - Street 1:2000 CLIFFMINE RD
Practice Address - Street 2:PARK WEST TWO, SUITE 110
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1008
Practice Address - Country:US
Practice Address - Phone:412-494-4550
Practice Address - Fax:412-494-6094
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
012310Medicare PIN