Provider Demographics
NPI:1275736399
Name:CAMPO, TRACEE LYNNE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEE
Middle Name:LYNNE
Last Name:CAMPO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 EAST ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1336
Mailing Address - Country:US
Mailing Address - Phone:401-413-6458
Mailing Address - Fax:
Practice Address - Street 1:655 DEDHAM ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1135
Practice Address - Country:US
Practice Address - Phone:508-384-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist