Provider Demographics
NPI:1962626903
Name:CAMPISE, JENNIFER CHRISTINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:CAMPISE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:BONFIGLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 BARRI DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642
Mailing Address - Country:US
Mailing Address - Phone:724-858-1084
Mailing Address - Fax:
Practice Address - Street 1:316 DONOHOE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6988
Practice Address - Country:US
Practice Address - Phone:724-837-8159
Practice Address - Fax:724-837-7453
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011789L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017071670005Medicaid