Provider Demographics
NPI:1942410535
Name:CAMPANANO, MARIA SHEILA LAJA (PT)
Entity Type:Individual
Prefix:MS
First Name:MARIA SHEILA
Middle Name:LAJA
Last Name:CAMPANANO
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1128 HARVEST BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4743
Mailing Address - Country:US
Mailing Address - Phone:770-601-8984
Mailing Address - Fax:770-574-4428
Practice Address - Street 1:1128 HARVEST BROOK DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4743
Practice Address - Country:US
Practice Address - Phone:770-601-8984
Practice Address - Fax:770-574-4428
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT008924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA315889908AMedicaid