Provider Demographics
NPI:1598250037
Name:CAMPOPIANO, LEA F (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:F
Last Name:CAMPOPIANO
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 BAY BRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1717
Mailing Address - Country:US
Mailing Address - Phone:407-232-0769
Mailing Address - Fax:
Practice Address - Street 1:865 S RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6414
Practice Address - Country:US
Practice Address - Phone:407-746-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL183700000X, 390200000X
FLAL59652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183700000XPharmacy Service ProvidersPharmacy Technician
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer