Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 01231 | OR |
NPI | 1003230434 |
---|---|
Provider Name | Jaqueline L Campagna |
First Address | Bend, OR 97708-6095 |
Second Address | Bend, OR 97701-6015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2014 |
Last Update Date | 05/02/2014 |