Provider Demographics
NPI:1215006986
Name:CAMP, SKYE D (PT)
Entity type:Individual
Prefix:
First Name:SKYE
Middle Name:D
Last Name:CAMP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7360 GOOLSBY RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-5280
Mailing Address - Country:US
Mailing Address - Phone:678-986-7551
Mailing Address - Fax:706-468-9361
Practice Address - Street 1:7360 GOOLSBY RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-5280
Practice Address - Country:US
Practice Address - Phone:678-986-7551
Practice Address - Fax:706-468-9361
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0064362251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA609253713AMedicaid