1538447602 NPI number — GABRIELLE A. CAMPAGNA DPT

Table of content: CINDY WIEDOFF (NPI 1992500417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538447602 NPI number — GABRIELLE A. CAMPAGNA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPAGNA
Provider First Name:
GABRIELLE
Provider Middle Name:
A.
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:
1538447602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 ORCHARD ST W
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
FIRCREST
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-6606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-564-1560
Provider Business Mailing Address Fax Number:
253-564-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7308 BRIDGEPORT WAY W
Provider Second Line Business Practice Location Address:
STE. 103
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-582-8142
Provider Business Practice Location Address Fax Number:
253-582-8160
Provider Enumeration Date:
07/24/2011

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: 225100000X , with the licence number:  60287927 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12412677 . This is a "CAQH PROVIDER ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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