Provider Demographics
NPI:1275939837
Name:CAPONE, SHANE (DPT)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:CAPONE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 ROUTE 9
Mailing Address - Street 2:BUILDING #2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4038
Mailing Address - Country:US
Mailing Address - Phone:732-240-9296
Mailing Address - Fax:732-240-9297
Practice Address - Street 1:555 LACEY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1500
Practice Address - Country:US
Practice Address - Phone:609-693-5055
Practice Address - Fax:609-693-0222
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01587000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ389907YC5Medicare PIN