Provider Demographics
NPI:1619311255
Name:CAMPOLO, DEBBIE (PT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:CAMPOLO
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 1:216 FISH HAWK LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1640
Mailing Address - Country:US
Mailing Address - Phone:610-908-5204
Mailing Address - Fax:
Practice Address - Street 1:125 SOUTHERN JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2214
Practice Address - Country:US
Practice Address - Phone:267-326-7389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011147L225100000X
SC.8777225100000X
GAPT013100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist