MEDICARE: GIANARA ELIZABETH CAMPASANO PT, DPT

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	225100000X	Physical Therapist	10309	AZ
2	225100000X	Physical Therapist	PT022675	PA

General Provider Information

NPI Number	:	1902244080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIANARA ELIZABETH CAMPASANO PT, DPT

Provider Business Mailing Address
First Line	:	15410 S MOUNTAIN PKWY STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6691
Country	:	US
Telephone Number	:	480-706-1161
Fax Number	:

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR STE F100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5606
Country	:	US
Telephone Number	:	602-866-0066
Fax Number	:

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

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	03/04/2020

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