Provider Demographics
NPI:1629138045
Name:KAMP, TRACI (DPT)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:
Last Name:KAMP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2002
Mailing Address - Country:US
Mailing Address - Phone:575-445-0111
Mailing Address - Fax:575-445-0112
Practice Address - Street 1:160 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2002
Practice Address - Country:US
Practice Address - Phone:575-445-0111
Practice Address - Fax:575-445-0112
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM348229301Medicare UPIN