Provider Demographics
NPI:1184867210
Name:CAMPISE, MARY A (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:CAMPISE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 POTOMAC PL
Mailing Address - Street 2:APT D
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-6915
Mailing Address - Country:US
Mailing Address - Phone:979-777-5460
Mailing Address - Fax:
Practice Address - Street 1:1806 POTOMAC PL
Practice Address - Street 2:APT D
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-6915
Practice Address - Country:US
Practice Address - Phone:979-777-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT024907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist