Provider Demographics
NPI:1487201224
Name:CAMPUS CARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CAMPUS CARE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NIVEDITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGALUR MANJUNATHA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:240-907-8898
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20704-1053
Mailing Address - Country:US
Mailing Address - Phone:240-907-8898
Mailing Address - Fax:
Practice Address - Street 1:4701 MELBOURNE PL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2540
Practice Address - Country:US
Practice Address - Phone:240-907-8898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty