Jennifer Iacampo, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

008171 Issued in CT

Practice address

150 Mansfield Ave
Willimantic, CT 06226-2026

Phone

(860) 456-2232

Fax

(860) 456-2256

NPI assigned

Aug 20, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Jennifer E. Rogers Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342051200000",
    "number": "1225221724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MANSFIELD AVE",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262026",
            "telephone_number": "860-456-2232",
            "fax_number": "860-456-2256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MANSFIELD AVE",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262026",
            "telephone_number": "860-456-2232",
            "fax_number": "860-456-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACAMPO",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-20",
        "last_updated": "2012-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "008171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC",
            "identifier": "080008171",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004271003",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "ROGERS",
            "middle_name": "E.",
            "prefix": "MS.",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Willimantic, CT
• Providers in Willimantic, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.