Provider Demographics
NPI:1871612093
Name:CAMP, ELIZABETH (PT MHS, CWS, CLT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:CAMP
Suffix:
Gender:F
Credentials:PT MHS, CWS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:866-518-0283
Mailing Address - Fax:
Practice Address - Street 1:10 VILLAGE WEST DR UNIT A
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-3602
Practice Address - Country:US
Practice Address - Phone:678-723-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004704225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7216OtherPERSONALCARE PROV ID
IL203OtherBLUE CROSS PROV ID
113326OtherHEALTHLINK PROV ID
IL4117OtherHAMP PROVIDER ID
140091Medicare ID - Type Unspecified