Healthcare Provider Details

I. General information

NPI: 1386588622
Provider Name (Legal Business Name): THOMAS CAMILLIERI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 S BROADWAY
DENVER CO
80210-5702
US

IV. Provider business mailing address

2565 S BROADWAY
DENVER CO
80210-5702
US

V. Phone/Fax

Practice location:
  • Phone: 720-546-8295
  • Fax:
Mailing address:
  • Phone: 720-546-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0015296
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: