MEDICARE: JILL C CAMPOLONGO PT

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	05009249A	IN
2	225100000X	Physical Therapist	PT012157	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225234396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL C CAMPOLONGO PT

Provider Business Mailing Address
First Line	:	PO BOX 411169
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-1169
Country	:	US
Telephone Number	:	888-830-4125
Fax Number	:

Provider Business Practice Location Address
First Line	:	7591 TYLERS PLACE BLVD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6308
Country	:	US
Telephone Number	:	137-556-6005
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	06/24/2022

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