MEDICARE: MRS. ANITA CAMPBELL LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	006476	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104925726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANITA CAMPBELL LPTA

Provider Business Mailing Address
First Line	:	11 HILLTOP LN
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 HILLTOP LN
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1303
Country	:	US
Telephone Number	:	631-920-6575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/09/2024

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