Provider Demographics
NPI:1295043453
Name:CAMPO, DAVID VICENTE (MT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:VICENTE
Last Name:CAMPO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 GRAND CANAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2575
Mailing Address - Country:US
Mailing Address - Phone:305-266-3334
Mailing Address - Fax:
Practice Address - Street 1:85 GRAND CANAL DR STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2575
Practice Address - Country:US
Practice Address - Phone:305-266-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA16156172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist