Provider Demographics
NPI:1093231219
Name:CAPOBIANCHI, MICHAEL JUDE JR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JUDE
Last Name:CAPOBIANCHI
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 S MCCLELLAND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3444
Mailing Address - Country:US
Mailing Address - Phone:215-622-6653
Mailing Address - Fax:
Practice Address - Street 1:3665 S 8400 W STE 210
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-4909
Practice Address - Country:US
Practice Address - Phone:801-250-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10403368-24012251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports