Gracie Anne Campbell, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT5222 Issued in AR

Practice address

9 Cunningham Corner
Bella Vista, AR 72714-3520

Phone

(479) 855-6814

Fax

(479) 855-6828

NPI assigned

Aug 26, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Gracie Anne Waters Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1053030593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 S GUTENSOHN",
            "address_2": "STE. 10",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727625117",
            "telephone_number": "479-751-7122",
            "fax_number": "479-751-7292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 CUNNINGHAM CORNER",
            "city": "BELLA VISTA",
            "state": "AR",
            "postal_code": "727143520",
            "telephone_number": "479-855-6814",
            "fax_number": "479-855-6828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2550 Airport Rd Ste J",
            "address_purpose": "LOCATION",
            "city": "Hot Springs",
            "state": "AR",
            "postal_code": "719132119",
            "country_code": "US",
            "telephone_number": "501-525-2273",
            "fax_number": "501-525-1773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "GRACIE",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-26",
        "last_updated": "2024-12-16",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT5222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR PHYSICAL THERAPY BOARD",
            "identifier": "PT5222",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300816721",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACIE",
            "last_name": "WATERS",
            "middle_name": "ANNE",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Bella Vista, AR
• Providers in Bella Vista, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.