Provider Demographics
NPI:1063449536
Name:CAMPAGNA, KATHARINE ELAINE (PT, DPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:ELAINE
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:MS
Other - First Name:KATHARINE
Other - Middle Name:MIDGETT
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, OCS
Mailing Address - Street 1:5290 ROSWELL RD
Mailing Address - Street 2:SUITE W
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1978
Mailing Address - Country:US
Mailing Address - Phone:404-477-5555
Mailing Address - Fax:404-477-5556
Practice Address - Street 1:5290 ROSWELL RD
Practice Address - Street 2:SUITE W
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1978
Practice Address - Country:US
Practice Address - Phone:404-477-5555
Practice Address - Fax:404-477-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I658269Medicare PIN
65BBCTFMedicare ID - Type Unspecified
GAQ31559Medicare UPIN