Healthcare Provider Details

I. General information

NPI: 1376454850
Provider Name (Legal Business Name): MICAH LEAH DANAE CAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICAH LEAH DANAE WILSON

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E RIDGEVILLE BLVD
MOUNT AIRY MD
21771-5217
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 240-732-2334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30920
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: