Provider Demographics
NPI:1073985602
Name:CAMPER, DARREN WAYNE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:WAYNE
Last Name:CAMPER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 GLEN LOCH LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:DE
Mailing Address - Zip Code:19954
Mailing Address - Country:US
Mailing Address - Phone:302-245-7549
Mailing Address - Fax:
Practice Address - Street 1:800 AIRPORT ROAD SUITE 102
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-424-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ20000793225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant