Provider Demographics
NPI:1417049917
Name:CAMPOPIANO, JASON A (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:CAMPOPIANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3279
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-7279
Mailing Address - Country:US
Mailing Address - Phone:518-409-4288
Mailing Address - Fax:518-409-4289
Practice Address - Street 1:9 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4301
Practice Address - Country:US
Practice Address - Phone:518-409-4288
Practice Address - Fax:518-409-4289
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0253571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7571526OtherAETNA
9056998OtherMVP
404581003OtherBLUE SHIELD
110079638002OtherCDPHP
451448236OtherBLUE CROSS
Q255T1OtherBLUE CROSS EPIN