Healthcare Provider Details

I. General information

NPI: 1497127914
Provider Name (Legal Business Name): MARGARET CAMPANARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 STADIUM TOWER
TROY AL
36082-0001
US

IV. Provider business mailing address

212 SUSSEX AVE
TROY AL
36081-4070
US

V. Phone/Fax

Practice location:
  • Phone: 334-670-3720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1702
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: