Provider Demographics
NPI:1245569565
Name:CAMPO, CATHERINE CLARITE (PT ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:CLARITE
Last Name:CAMPO
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20318 BOTHELL EVERETT HWY
Mailing Address - Street 2:A204
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7156
Mailing Address - Country:US
Mailing Address - Phone:425-949-5469
Mailing Address - Fax:
Practice Address - Street 1:1250 NE 145TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7134
Practice Address - Country:US
Practice Address - Phone:206-957-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005808225200000X
WAP160129470225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant