Provider Demographics
NPI:1073399937
Name:LOUIE, CAMILLE DENISE (PTA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:DENISE
Last Name:LOUIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3506
Mailing Address - Country:US
Mailing Address - Phone:650-323-4440
Mailing Address - Fax:540-323-4441
Practice Address - Street 1:3441 ALMA ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3506
Practice Address - Country:US
Practice Address - Phone:650-323-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52808225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant