Provider Demographics
NPI:1033174438
Name:CAPERNA, KRISTEN N (PT, PA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:CAPERNA
Suffix:
Gender:F
Credentials:PT, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 ABBOTT WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1440
Mailing Address - Country:US
Mailing Address - Phone:410-203-2283
Mailing Address - Fax:
Practice Address - Street 1:5051 GREENSPRING AVE STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4358
Practice Address - Country:US
Practice Address - Phone:410-601-7790
Practice Address - Fax:410-601-1470
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004512363A00000X
MD21200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist