Provider Demographics
NPI:1578603171
Name:KAMPA, PATRICIA JEAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JEAN
Last Name:KAMPA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28651 SUNNY BEACH RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4558
Mailing Address - Country:US
Mailing Address - Phone:218-326-1182
Mailing Address - Fax:
Practice Address - Street 1:15 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2760
Practice Address - Country:US
Practice Address - Phone:218-326-2200
Practice Address - Fax:218-326-2977
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist