MEDICARE: MICHELE DENISE CAMERON 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
1	225200000X	Physical Therapy Assistant	000997-1	NY

General Provider Information

NPI Number	:	1528610821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE DENISE CAMERON PTA

Provider Business Mailing Address
First Line	:	131 LAWRENCE ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1399
Country	:	US
Telephone Number	:	518-691-1451
Fax Number	:	518-691-1460

Provider Business Practice Location Address
First Line	:	131 LAWRENCE ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1399
Country	:	US
Telephone Number	:	518-691-1454
Fax Number	:	518-691-1460

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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