1326685546 NPI number — ELISABETH WENTLENT CAMPBELL DPT

Table of content: ELISABETH WENTLENT CAMPBELL DPT (NPI 1326685546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326685546 NPI number — ELISABETH WENTLENT CAMPBELL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
ELISABETH
Provider Middle Name:
WENTLENT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326685546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2561 LAC DE VILLE BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-473-1290
Provider Business Mailing Address Fax Number:
585-869-5142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 MAIN ST STE 5A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-408-5200
Provider Business Practice Location Address Fax Number:
585-869-5142
Provider Enumeration Date:
12/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 041081 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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