Provider Demographics
NPI:1356564256
Name:OCAMPOS, BERNADETTE CHUA (RPT)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:CHUA
Last Name:OCAMPOS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1430 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3202
Practice Address - Country:US
Practice Address - Phone:863-680-7700
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 10695OtherLICENSE NUMBER
FL1316016801OtherNPI GROUP NUMBER
FLE6955ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER