Shea KL Campbell, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

11726 Issued in AZ

Practice address

12691 W Smokey Dr Ste 128
Surprise, AZ 85378-3801

Phone

(623) 234-4171

Fax

(623) 234-4173

NPI assigned

Aug 10, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Modern Sports Medicine LLCGroup PAC ID 6800228479, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Modern Sports Medicine LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Sun Lakes, AZ
  • NPI 1285295089

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Rise Orthopedic and Sports Physical Therapy LLC

  • Orthopedic Physical Therapist
  • Surprise, AZ
  • NPI 1366953549
  Medicare reassignment NPD
• Modern Sports Medicine LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Tucson, AZ
  • NPI 1609662709
  NPD
• Mountainside Fitness Acquisitions

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Scottsdale, AZ
  • NPI 1023606878
  NPD (past)

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1871979195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12691 W SMOKEY DR STE 128",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853783801",
            "telephone_number": "623-234-4171",
            "fax_number": "623-234-4173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12691 W SMOKEY DR STE 128",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853783801",
            "telephone_number": "623-234-4171",
            "fax_number": "623-234-4173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "SHEA",
        "middle_name": "KL",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-10",
        "last_updated": "2022-12-08",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AZ",
            "license": "11726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcie Marie Camblin, MSN, ACNPC-AG, CCRN
• Andrea Lauren-Nicole Campbell, PHARM D
• Bobbi-Jo Campbell, FNP-C
• Jill Marie Campbell, COTA/L
• Kylie E Campbell
• Amy Maria Cannatta, DC
• Victoria L Cannoles, LMT
• Cynthia Rae Cannon
• Lori Cannon, NP-C
• Canyon Modern Dentistry & Orthodontics

• Orthopedic Physical Therapist in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Orthopedic Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.