Kevin Campbell, PTA

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36001279A Issued in IN

Practice address

474 S Landmark Ave
Bloomington, IN 47403-5000

Phone

(812) 727-3651

NPI assigned

Aug 21, 2014

Last updated

Sep 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kenney Orthopedics of Bloomington, LLC

  dba Hanger Clinic

  • Prosthetic/Orthotic Supplier
  • Bloomington, IN
  • NPI 1720569544
  NPD

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1205235629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3524 S WICKENS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035000",
            "telephone_number": "812-727-3651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3524 S Wickens St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474034514",
            "country_code": "US",
            "telephone_number": "317-918-5767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KEVIN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-21",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06003728A",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36001279A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renae Cameron, LCSW
• Gracie Camp, RBT
• Khaled Amat Campa, MD
• Campbell Chiropractic and Rehabilitation
• Connor Scott Campbell, PA-C
• Laura L Campbell
• Liza Marie Campbell, DC
• Lori K Campbell, PH.D., HSPP
• Marcia Jo Campbell, MD
• William T. Campbell III, M.D.

• Athletic Trainer in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; 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.