Provider Demographics
NPI:1750654414
Name:CAMPOLIETI, JOHN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CAMPOLIETI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S GREEN RD
Mailing Address - Street 2:SUITE 036
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4129
Mailing Address - Country:US
Mailing Address - Phone:216-291-2277
Mailing Address - Fax:216-291-5707
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:SUITE 036
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4129
Practice Address - Country:US
Practice Address - Phone:216-291-2277
Practice Address - Fax:216-291-5707
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist