Provider Demographics
NPI:1972542496
Name:CAMPANELLA, ALICE CHIU (MPT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:CHIU
Last Name:CAMPANELLA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COLFAX LN
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-4818
Mailing Address - Country:US
Mailing Address - Phone:609-518-7393
Mailing Address - Fax:
Practice Address - Street 1:220 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4403
Practice Address - Country:US
Practice Address - Phone:856-910-7502
Practice Address - Fax:856-910-7505
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00675200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist