Provider Demographics
NPI:1609899970
Name:CAMPASANO, LOUIS JR (PT)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:CAMPASANO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 TORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8123
Mailing Address - Country:US
Mailing Address - Phone:732-575-0438
Mailing Address - Fax:
Practice Address - Street 1:515 TORRINGTON DR
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8123
Practice Address - Country:US
Practice Address - Phone:732-575-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10943208100000X, 225100000X
NJ40QA01100900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
087888R32Medicare ID - Type Unspecified