Provider Demographics
NPI:1467581603
Name:OCAMPO, REYMON DAVID (PT)
Entity Type:Individual
Prefix:
First Name:REYMON
Middle Name:DAVID
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HAMILTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2668
Mailing Address - Country:US
Mailing Address - Phone:863-286-1836
Mailing Address - Fax:888-847-0781
Practice Address - Street 1:905 HAMILTON PLACE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2668
Practice Address - Country:US
Practice Address - Phone:863-286-1836
Practice Address - Fax:863-286-1836
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY910GOtherBCBS GROUP NO.
FLE6970ZMedicare ID - Type UnspecifiedINDIVIDUAL NO.
FLK0936Medicare ID - Type UnspecifiedGROUP NO.