Provider Demographics
NPI:1114426996
Name:CAPOBIANCO, LEANN MAYBIN
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:MAYBIN
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GOODWIN FARMS CT
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-7609
Mailing Address - Country:US
Mailing Address - Phone:828-696-6597
Mailing Address - Fax:
Practice Address - Street 1:3300 POINSETT HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29613-0002
Practice Address - Country:US
Practice Address - Phone:864-241-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3658225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant