Provider Demographics
NPI:1033660105
Name:KAISER, CAMILLE
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 WITTINGTON PL
Mailing Address - Street 2:STE. 175
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1927
Mailing Address - Country:US
Mailing Address - Phone:214-442-4210
Mailing Address - Fax:
Practice Address - Street 1:1755 WITTINGTON PL
Practice Address - Street 2:STE. 175
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-1927
Practice Address - Country:US
Practice Address - Phone:214-442-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12787502251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics