Provider Demographics
NPI:1578882429
Name:KEMP CAMPBELL, TARNEESHA
Entity Type:Individual
Prefix:
First Name:TARNEESHA
Middle Name:
Last Name:KEMP CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SAINT JOHNS PL APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3771
Mailing Address - Country:US
Mailing Address - Phone:347-406-9787
Mailing Address - Fax:
Practice Address - Street 1:1315 SAINT JOHNS PL APT 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3771
Practice Address - Country:US
Practice Address - Phone:347-406-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006931-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant