Basic Information
| Provider Information | |||||||||
| NPI: | 1770890543 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | SCHNELL | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHNELL | ||||||||
| OtherFirstName: | CATHERINE | ||||||||
| OtherMiddleName: | PATRICIA | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 36 W 44TH ST | ||||||||
| Address2: | STE 403 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100368102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592280 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 390 EMPIRE RD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800262605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202165128 | ||||||||
| FaxNumber: | 7203166744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2010 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0329391 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.