Provider Demographics
NPI:1548572936
Name:CAMPOSEO, LEAH C (DPT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:C
Last Name:CAMPOSEO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:C
Other - Last Name:CONNARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:224 ANDERSON PL
Mailing Address - Street 2:LOWER
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1804
Mailing Address - Country:US
Mailing Address - Phone:716-861-3075
Mailing Address - Fax:716-861-3075
Practice Address - Street 1:224 ANDERSON PL
Practice Address - Street 2:LOWER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1804
Practice Address - Country:US
Practice Address - Phone:716-861-3075
Practice Address - Fax:716-861-3075
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist