Basic Information
| Provider Information | |||||||||
| NPI: | 1669858916 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPAGNOLA | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 15TH ST | ||||||||
| Address2: | |||||||||
| City: | BAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117092332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169656696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5800 3RD AVE | ||||||||
| Address2: | MANAGED CARE DEPARTMENT | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112203702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186308298 | ||||||||
| FaxNumber: | 7186307437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2015 | ||||||||
| LastUpdateDate: | 08/09/2015 | ||||||||
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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 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.