Provider Demographics
NPI:1821563347
Name:CAMPO, TARAH MARIE (PT)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:MARIE
Last Name:CAMPO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:MARIE
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1305
Mailing Address - Country:US
Mailing Address - Phone:607-770-0025
Mailing Address - Fax:
Practice Address - Street 1:941 STATE ROUTE 17C
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-4819
Practice Address - Country:US
Practice Address - Phone:607-972-2990
Practice Address - Fax:607-972-2999
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist