Provider Demographics
NPI:1225255029
Name:CAPINJOLA, HEATHER NAOMI (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NAOMI
Last Name:CAPINJOLA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:NAOMI
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43475 DALCOMA DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3591
Practice Address - Country:US
Practice Address - Phone:586-421-7461
Practice Address - Fax:586-408-6078
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211124Medicare PIN