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General NPI Number Information
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NPI Number | 1760810261
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Entity Type | Individual
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Provider Name | MICHAEL CAMACHO PT, DPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 2 BRIGHTON RD STE 406
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City | CLIFTON
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State | NJ
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Zip | 07012-1669
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Country | US
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Telephone | 201-396-0523
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Fax |
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Provider Business Mailing Address
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Address Line | 127 LEE ST
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-2110
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA01471300
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License Number State | NJ
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