Provider Demographics
NPI:1699938126
Name:CAMPBELL, SUZANN K (PT)
Entity type:Individual
Prefix:DR
First Name:SUZANN
Middle Name:K
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W MADISON ST
Mailing Address - Street 2:#526
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1936
Mailing Address - Country:US
Mailing Address - Phone:312-733-9604
Mailing Address - Fax:312-733-0565
Practice Address - Street 1:1301 W MADISON ST
Practice Address - Street 2:#526
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1936
Practice Address - Country:US
Practice Address - Phone:312-733-9604
Practice Address - Fax:312-733-0565
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0051472251P0200X
NC7362251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics