Provider Demographics
NPI:1780995142
Name:CAMPOMANES, KATHERINE KAYE T (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KATHERINE KAYE
Middle Name:T
Last Name:CAMPOMANES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:T
Other - Last Name:CAMPOMANES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:10115 77TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1904
Mailing Address - Country:US
Mailing Address - Phone:646-387-6264
Mailing Address - Fax:
Practice Address - Street 1:10115 77TH ST FL 1
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1904
Practice Address - Country:US
Practice Address - Phone:646-387-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0225952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics