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NPI Code Detail

MEDICARE: MS. JEANETTE ELIZABETH CAMPAGNOLA PTA

MEDICARE: MS. JEANETTE ELIZABETH CAMPAGNOLA PTA
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
1225200000XPhysical Therapy Assistant940-019WI

Other Identifiers

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

General Provider Information

NPI Number : 1467666974
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEANETTE ELIZABETH CAMPAGNOLA PTA
Provider Business Mailing Address
First Line : 4529 S GRIFFIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-5863
Country : US
Telephone Number : 414-481-4269
Fax Number :
Provider Business Practice Location Address
First Line : 2727 W MITCHELL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2259
Country : US
Telephone Number : 141-383-3699
Fax Number : 414-383-3866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 07/08/2007

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