Provider Demographics
NPI:1306800263
Name:CAMARATA, TERESA J (PT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:CAMARATA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RYE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6839
Mailing Address - Country:US
Mailing Address - Phone:603-610-2200
Mailing Address - Fax:603-610-2202
Practice Address - Street 1:15 RYE ST STE 125
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6839
Practice Address - Country:US
Practice Address - Phone:603-610-2200
Practice Address - Fax:603-610-2202
Is Sole Proprietor?:No
Enumeration Date:2006-04-16
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH1416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08Y008750NH02OtherANTHEM BLUE CROSS/BLUE SH
NH30393895Medicaid
NE08Y008750NH02OtherANTHEM BLUE CROSS/BLUE SH