Basic Information
| Provider Information | |||||||||
| NPI: | 1306800263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMARATA | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 RYE ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038016839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036102200 | ||||||||
| FaxNumber: | 6036102202 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 RYE ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038016839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036102200 | ||||||||
| FaxNumber: | 6036102202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2006 | ||||||||
| LastUpdateDate: | 04/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | NH1416 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 08Y008750NH02 | 01 | NE | ANTHEM BLUE CROSS/BLUE SH | OTHER |