Provider Demographics
NPI:1871354142
Name:CAMPOS, POONAM (PT, DPT)
Entity type:Individual
Prefix:
First Name:POONAM
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 N CENTRAL EXPY STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6764
Mailing Address - Country:US
Mailing Address - Phone:972-232-2227
Mailing Address - Fax:
Practice Address - Street 1:11300 N CENTRAL EXPY STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6764
Practice Address - Country:US
Practice Address - Phone:972-232-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1387055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist