Provider Demographics
NPI:1255830634
Name:CAMPOPIANO, CORY (ATC)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:
Last Name:CAMPOPIANO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39/12-16 SOI NICHADA THANI, SAMAKEE ROAD
Mailing Address - Street 2:SAMAKEE GARDENS APT #5B
Mailing Address - City:PAKKRET
Mailing Address - State:NONTHABURI
Mailing Address - Zip Code:11120
Mailing Address - Country:TH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39/12-16 SOI NICHADA THANI, SAMAKEE ROAD
Practice Address - Street 2:SAMAKEE GARDENS APT #5B
Practice Address - City:PAKKRET
Practice Address - State:NONTHABURI
Practice Address - Zip Code:11120
Practice Address - Country:TH
Practice Address - Phone:678-702-3976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20000199102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2000019910OtherBOARD OF CERTIFICATION