MEDICARE: MRS. TRACEE LYNNE CAMPO MSPT

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	16653	MA

General Provider Information

NPI Number	:	1275736399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACEE LYNNE CAMPO MSPT

Provider Business Mailing Address
First Line	:	431 EAST ST
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1336
Country	:	US
Telephone Number	:	401-413-6458
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 DEDHAM ST
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1135
Country	:	US
Telephone Number	:	508-384-3405
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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