Provider Demographics
NPI:1598122095
Name:CAMPISANO, MIRANDA (PT)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:
Last Name:CAMPISANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 THOMPSON HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1608
Mailing Address - Country:US
Mailing Address - Phone:916-709-6694
Mailing Address - Fax:
Practice Address - Street 1:7010 ROWAN HILL DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3380
Practice Address - Country:US
Practice Address - Phone:513-527-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist