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General NPI Number Information
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NPI Number | 1417175126
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Entity Type | Individual
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Provider Name | ELIZABETH CAMPOS PT CLT
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 231 WASHINGTON AVE ST MARKS PHYSICAL THERAPY
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City | GARDEN CITY
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State | NY
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Zip | 11530
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Country | US
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Telephone | 516-746-0276
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Fax | 516-248-4661
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Provider Business Mailing Address
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Address Line | PO BOX 1045
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City | NEW YORK
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State | NY
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Zip | 10018-9998
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Country | US
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Telephone | 917-202-3652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0273461
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License Number State | NY
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