Provider Demographics
NPI:1801789771
Name:OCAMPO, JUAN (DPT)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 223RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:WI
Mailing Address - Zip Code:53104-9327
Mailing Address - Country:US
Mailing Address - Phone:224-308-8423
Mailing Address - Fax:
Practice Address - Street 1:1177 QUAIL CT STE 200
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3768
Practice Address - Country:US
Practice Address - Phone:224-308-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy