MEDICARE: DR. ANDRAY AINSWORTH CAMPBELL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	043956	NY

General Provider Information

NPI Number	:	1053882571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRAY AINSWORTH CAMPBELL DPT

Provider Business Mailing Address
First Line	:	672 PARKSIDE AVE FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2298
Country	:	US
Telephone Number	:	718-679-9455
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 PARKSIDE AVE FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2298
Country	:	US
Telephone Number	:	718-679-9455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/10/2018

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