Provider Demographics
NPI:1225412398
Name:CAPOZUCCA, CARA
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:CAPOZUCCA
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 1:450 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSTON TWP.
Mailing Address - State:PA
Mailing Address - Zip Code:18640
Mailing Address - Country:US
Mailing Address - Phone:570-237-2236
Mailing Address - Fax:
Practice Address - Street 1:450 BROAD STREET
Practice Address - Street 2:
Practice Address - City:PITTSTON TWP.
Practice Address - State:PA
Practice Address - Zip Code:18640
Practice Address - Country:US
Practice Address - Phone:570-237-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20000220072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer